NPIMap

Organization Active NPI

Montgomery County Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Red Oak, IA
National Provider Identifier
1831162023
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
690075H Issued in IA
Legal business name
MONTGOMERY COUNTY MEMORIAL HOSPITAL
Practice address
2301 Eastern Ave
Red Oak, IA 51566-1305
Phone
(712) 623-7000
Fax
(712) 623-7224
NPI assigned
Feb 9, 2006
Last updated
Dec 6, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MONTGOMERY COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ronald G Kloewer
Title
Administrator/Ceo
Phone
(712) 623-7000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 690075H IA Primary
Critical Access Hospital 282NC0060X 690075H IA
Skilled Nursing Facility 314000000X 690075H IA

Addresses

Primary practice location

2301 Eastern Ave
Red Oak, IA 51566-1305

Mailing address

PO Box 498
Red Oak, IA 51566-0498
Phone (712) 623-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070129000283 IA Part A Provider - Critical Access Hospital 9032015805 Practice locations: Red Oak, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831162023. Details of each certification follow.

Hospital certification: CCN 16Z363

Legal name
MONTGOMERY COUNTY MEMORIAL HOSPITAL
Doing business as
MONTGOMERY COUNTY MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
2301 Eastern Ave
Red Oak, IA 51566-1305
Hospital Swing-Bed Unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Montogomery Co Mem Hosp11 organizations share this tax ID, including this one
Part of
Montogomery Co Mem Hosp

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Daniela M Donoso Pena Individual W-2 Managing EmployeeChief of Staff Jul 1, 2022
Operational/Managerial ControlChief of Staff Jul 1, 2022
Jason R Poston Individual Corporate Director Jan 1, 2023
Ann M Carder Individual Corporate Director Jan 1, 2021
Jill C Bergstrom Individual Corporate Director Jan 1, 2019
James C Norris Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 1, 2021
Michael C Oneal Individual W-2 Managing EmployeeCoo Oct 31, 2021
Operational/Managerial ControlCoo Oct 31, 2021
Roger J Ehmke Individual Corporate Officer Jan 1, 2021
Corporate Director Jan 1, 1999
Kevin T Cabbage Individual Corporate Officer Jan 1, 2016
Corporate Director Jan 1, 2007
Lorin E Petersen Individual Corporate Officer Jan 1, 2019
Corporate Director Mar 3, 2000
Ronald G Kloewer Individual Corporate OfficerAdministrator/Ceo Mar 15, 2021
W-2 Managing EmployeeAdministrator/Ceo Mar 15, 2021
Operational/Managerial ControlAdministrator/Ceo Mar 15, 2021
Jamie L Hossle Individual W-2 Managing EmployeeDirector Revenue Cycle Jun 27, 2022
Operational/Managerial ControlDirector Revenue Cycle Jun 27, 2022
Bryant J Blay Individual Corporate OfficerCfo Dec 31, 2022
W-2 Managing EmployeeCfo Apr 18, 2016
Operational/Managerial ControlCfo Apr 18, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1831162023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 498",
            "city": "RED OAK",
            "state": "IA",
            "postal_code": "515660498",
            "telephone_number": "712-623-7000",
            "fax_number": "712-623-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 EASTERN AVE",
            "city": "RED OAK",
            "state": "IA",
            "postal_code": "515661305",
            "telephone_number": "712-623-7000",
            "fax_number": "712-623-7224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTGOMERY COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-02-09",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "KLOEWER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "712-623-7000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IA",
            "license": "690075H",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "690075H",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "690075H",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Oak, IA

Sources for this page

Verify at the official NPI Registry.