Jefferson County Hospital
Organization Active NPI Rural Health Clinic/Center · Richland, IA
NPI 1881294536 · NPPES record last updated Nov 2, 2020
Key facts
- NPI
- 1881294536
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- JEFFERSON COUNTY HOSPITAL
- Practice address
- 107 W Harrison St
Richland, IA 52585-9549 - Phone
- (641) 469-4309
- Fax
- (641) 469-4440
- NPI assigned
- Oct 30, 2020
- Organization subpart
- No
Authorized official
- Name
- Larry Dale Peach
- Title
- Cfo
- Phone
- (641) 469-4304
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 10
Member of 1
Practitioners 91
-
Mark Christopher Boswell, CRNA
-
Dustin C Bozwell, CRNA/ARNP
-
Sarah Elizabeth Brecount, ARNP
-
Taylor Madison Buch, ARNP
-
Jim A Buck, M.D.
-
Richard Nielson Curtis, M.D.
-
Shelbi Dexter, ARNP
-
Heather E Easton, ARNP
-
Jill Ferrell, CRNA
-
Andrew John Friessen, D.O.
-
Mary Helen Gartin, ARNP
-
Melissa Dewitte Gonzalez, CRNA
-
Robert J Goodwill, M.D.
-
Mark J Haganman, DO
-
Joni R Hanshaw, CRNP
-
Nilfar Karimova, M.D.
-
Gloria Renee Lafollette, RN, DNP, FNP-C
-
Grant Landon, DO
-
David Kent Larson, M.D.
-
Vishaun Lawrence, FNP
-
Sumin Tammy Li, M.D.
-
Tanetta C Main, RN, FNP
-
Brian Marovets, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D2222107 | JCHC Richland Clinic | Certificate of waiver | Apr 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Jefferson County Health Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2004 |
| Jefferson County Health Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2004 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Jefferson Co Hospitla
Locations
201 N Richland St
Richland, IA 52585
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- JCHC Richland Clinic
Other providers in Richland, IA
- Kristina Ann Halbur
- Hello Chiropractic LLC
- Shilo James Hilger
- Ashley Nicole Jones
- River Hills Community Health Center Keokuk Co Clinic
- Jenny Ann Roth
- Elizabeth Tolle
- Weber Chiropractic
All providers in Richland, IA · Rural Health Clinic/Center in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.