Medical Clinic LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

MEDICAL CLINIC LLC

Practice address

710 Center St
Tabor, IA 51653-2069

Phone

(712) 629-2975

NPI assigned

Feb 8, 2006

Last updated

Aug 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cristin A Hendrickson

Title

Ceo

Phone

(712) 382-1515

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• MEDICAL CLINIC P.C. Former legal business name

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841263233. Details of each certification follow.

• CCN 163836 Rural health clinic · Active · Details

Rural health clinic certification: CCN 163836

Legal name

MEDICAL CLINIC LLC

Doing business as

MEDICAL CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 19, 1993

Last certification

Sep 14, 2021

Ownership / control type

1B

Organization structure

LLCNon-profit

Enrollment address

710 Center St
Tabor, IA 51653-2069

Other NPIs with the same Medicare PAC ID 3

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

• Medical Clinic LLC

  • Family Medicine Physician
  • Hamburg, IA
  • NPI 1124218706

  5395634216

  Same PAC ID
• Medical Clinic LLC

  • Rural Health Clinic/Center
  • Sidney, IA
  • NPI 1871566265

  5395634216

  Same PAC ID
• Medical Clinic LLC

  • Rural Health Clinic/Center
  • Hamburg, IA
  • NPI 1972575595

  5395634216

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Medical Clinic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Medical Clinic LLC

  • Rural Health Clinic/Center
  • Sidney, IA
  • NPI 1871566265
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Community Hospital Inc

  dba George C. Grape Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Hamburg, IA
  • NPI 1124114145

  Member Of

  NPD member

All disclosed owners & managing parties 4

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

Owners & managing parties with NPI records 4

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

• Community Hospital Inc

  • Emergency Medicine Physician
  • Hamburg, IA
  • NPI 1124112677

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership
• Community Hospital Inc

  dba George C. Grape Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Hamburg, IA
  • NPI 1124114145

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership
• Community Hospital Inc

  dba George C. Grape Community Hospital

  • Critical Access Hospital
  • Hamburg, IA
  • NPI 1932294071

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership
• Michael Ourada, MD

  • Family Medicine Physician
  • Hamburg, IA
  • NPI 1427164789

  Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Medical Clinic LLC

  • Rural Health Clinic/Center
  • Sidney, IA
  • NPI 1871566265

  Community Hospital Inc

  CMS ownership
• Medical Clinic LLC

  • Rural Health Clinic/Center
  • Hamburg, IA
  • NPI 1972575595

  Community Hospital Inc

  CMS ownership

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1841263233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 MAIN ST",
            "city": "HAMBURG",
            "state": "IA",
            "postal_code": "516401300",
            "telephone_number": "712-382-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 CENTER ST",
            "city": "TABOR",
            "state": "IA",
            "postal_code": "516532069",
            "telephone_number": "712-629-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "CRISTIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-382-1515"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018507",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0638361",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BC/BS OF IA",
            "identifier": "13034",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL CLINIC P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Fremont C.S.D.
• Kristin J Golden, ARNP
• Kathleen Rae Griner, OTD, OTR/L
• Jessica Anne Heitkamp, APRN
• Brenda McCollum
• Stefanie Ann Naumowicz
• Physicians Clinic, Inc. (Methodist Physicians Clinic)
• Mellenie Porter, T-LMHC
• Renew Mental Health LLC
• Megan Lianne Ruff

• Rural Health Clinic/Center in Tabor, IA
• Providers in Tabor, IA by specialty
• Rural Health Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.