Montgomery County Memorial Hospital
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Red Oak, IA
NPI 1831162023 · NPPES record last updated Dec 6, 2022
Key facts
- NPI
- 1831162023
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 690075H (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
- Organization subpart
- Yes
- Parent organization (as reported)
- MONTGOMERY COUNTY MEMORIAL HOSPITAL
Authorized official
- Name
- Mr. Ronald G Kloewer
- Title
- Administrator/Ceo
- Phone
- (712) 623-7000
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 10
Related certifications (CCN) 1
Practitioners 44
-
Thomas M Baer, M.D.
-
Claudia M. Balta, P.A.
-
William Butz, M.D.
-
Brian E. Couse, MD
-
Warren C Hayes, M.D.
-
Scott D. Hoffman, D.O.
-
Abby Johnson, FNP-C
-
Kelsey Brooke Johnson, ARNP
-
Lizabeth Jean Johnson, APRN
-
Eva-Anne Marie Kentner, ARNP
-
Angela Marie Kerchner, M.D.
-
Jason Troy Lihs, CRNA
-
Emily L Maass, APRN
-
Sumit Mukherjee, M.D.
-
Christopher Olsen, ARNP
-
David Michael Owen, A.R.N.P.
-
Jeremy P Pepin, M.D.
-
Ara J Robinson, D.O.
-
Colleen M Ross, NP
-
Brianna Jean Schaffer, ARNP
Affiliated clinicians 5
-
Yulia Johnson, D.O.
-
Angela Marie Kerchner, M.D.
-
Christopher Olsen, ARNP
-
Tu Anh Luong, MD
-
Crystal Vinas, AGPNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Hospital certification: CCN 16Z363
- Legal name
- MONTGOMERY COUNTY MEMORIAL HOSPITAL
- Doing business as
- MONTGOMERY COUNTY MEMORIAL HOSPITAL
- Organization structure
- Other · Non-profit
- Enrollment address
- 2301 Eastern Ave
Red Oak, IA 51566-1305
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Daniela M Donoso Pena |
W-2 Managing Employee |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Jason R Poston |
Corporate Director | Jan 1, 2023 | |
| Ann M Carder |
Corporate Director | Jan 1, 2021 | |
| Jill C Bergstrom |
Corporate Director | Jan 1, 2019 | |
| James C Norris |
Corporate Officer | Jan 1, 2023 | |
| Corporate Director | Jan 1, 2021 | ||
| Michael C Oneal |
W-2 Managing Employee |
Oct 31, 2021 | |
| Operational/Managerial Control |
Oct 31, 2021 | ||
| Roger J Ehmke |
Corporate Officer | Jan 1, 2021 | |
| Corporate Director | Jan 1, 1999 | ||
| Kevin T Cabbage |
Corporate Officer | Jan 1, 2016 | |
| Corporate Director | Jan 1, 2007 | ||
| Lorin E Petersen |
Corporate Officer | Jan 1, 2019 | |
| Corporate Director | Mar 3, 2000 | ||
| Ronald G Kloewer |
Corporate Officer |
Mar 15, 2021 | |
| W-2 Managing Employee |
Mar 15, 2021 | ||
| Operational/Managerial Control |
Mar 15, 2021 | ||
| Jamie L Hossle |
W-2 Managing Employee |
Jun 27, 2022 | |
| Operational/Managerial Control |
Jun 27, 2022 | ||
| Bryant J Blay |
Corporate Officer |
Dec 31, 2022 | |
| W-2 Managing Employee |
Apr 18, 2016 | ||
| Operational/Managerial Control |
Apr 18, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070129000283 | IA | Part a Provider - Critical Access Hospital | 9032015805 | Practice locations: Red Oak, IA |
National Provider Directory
- Tax ID family
- Montgomery County Memorial Hospital
- Part of
- Montgomery County Memorial Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 690075H | IA | Yes |
| 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
Other providers in Red Oak, IA
- Montgomery County Memorial Hospital
- Montgomery County Memorial Hospital
- Montgomery County Memorial Hospital
- Montgomery County Memorial Hospital
- Montgomery County Memorial Hospital
- Montgomery County Memorial Hospital
- Montgomery County Memorial Hospital
- Martin Damien Mulligan
- Etta Murphy
- Andrew Cole Nelson
All providers in Red Oak, IA · Medicare Defined Swing Bed Hospital Unit in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.