NPIMap

Organization Active NPI

Jefferson County Hospital

Doing business as JCHC Richland Clinic

  • Rural Health Clinic/Center
  • Richland, IA
National Provider Identifier
1881294536
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JEFFERSON COUNTY HOSPITAL
Doing business as
JCHC Richland Clinic
Practice address
107 W Harrison St
Richland, IA 52585-9549
Phone
(641) 469-4309
Fax
(641) 469-4440
NPI assigned
Oct 30, 2020
Last updated
Nov 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Authorized official

Name
Larry Dale Peach
Title
Cfo
Phone
(641) 469-4304

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

107 W Harrison St
Richland, IA 52585-9549

Mailing address

2000 S Main St
Fairfield, IA 52556-9572
Phone (641) 469-4309

Other names 1

  • JCHC Richland Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031223000606 IA Part B Supplier - Clinic/Group Practice 9335059575 Receives reassigned benefits from 86 practitioners
5 other NPIs on this enrollment
Practice locations: Fairfield, IA; Richland, IA

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2222107JCHC Richland Clinic107 W Harrison, Richland, IA 52585Certificate of waiverApr 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Co Hospitla11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Member of 1

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

Locations

2000B S Main St
Fairfield, IA 52556
Phone (641) 472-4156

201 N Richland St
Richland, IA 52585

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jefferson County Health CenterFairfield, IA, CCN 161364 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2004
Jefferson County Health CenterFairfield, IA, CCN 16Z364 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2004

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 90

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.

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1881294536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 S MAIN ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525569572",
            "telephone_number": "641-469-4309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 W HARRISON ST",
            "city": "RICHLAND",
            "state": "IA",
            "postal_code": "525859549",
            "telephone_number": "641-469-4309",
            "fax_number": "641-469-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-30",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "PEACH",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "641-469-4304"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JCHC Richland Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JCHC Richland Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richland, IA

Sources for this page

Verify at the official NPI Registry.