Active NPI
Five Star Quality Care Ia LLC
- Skilled Nursing Facility
- Mediapolis, IA
National Provider Identifier
1891740213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 290810
- Legal business name
- FIVE STAR QUALITY CARE IA LLC
- Practice address
- 608 Prairie St
Mediapolis, IA 52637-7843 - Phone
- (319) 394-3991
- Fax
- (319) 394-3041
- NPI assigned
- May 24, 2006
- Organization subpart
- Yes
- Parent organization
- FIVE STAR QUALITY CARE IA LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Katherine E Potter
- Title
- President & Chief Executive Officer
- Phone
- (617) 796-8387
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 290810 | IN | Primary |
Addresses
Primary practice location
608 Prairie St
Mediapolis, IA 52637-7843
Mailing address
608 Prairie St
Mediapolis, IA 52637-7843
Phone (319) 394-3991
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0805382 | Medicaid | IA |
Other names 1
- Prairie Ridge Care & Rehabilitation
National Provider Directory
National Provider Directory- Part of
- Five Star Quality Care Ia LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1553731200000",
"number": "1891740213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "608 PRAIRIE ST",
"city": "MEDIAPOLIS",
"state": "IA",
"postal_code": "526377843",
"telephone_number": "319-394-3991",
"fax_number": "319-394-3041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "608 PRAIRIE ST",
"city": "MEDIAPOLIS",
"state": "IA",
"postal_code": "526377843",
"telephone_number": "319-394-3991",
"fax_number": "319-394-3041"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FIVE STAR QUALITY CARE IA LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FIVE STAR QUALITY CARE IA LLC",
"enumeration_date": "2006-05-24",
"last_updated": "2019-03-28",
"status": "A",
"authorized_official_last_name": "POTTER",
"authorized_official_first_name": "KATHERINE",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "617-796-8387"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IN",
"license": "290810",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0805382",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Prairie Ridge Care & Rehabilitation",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Prairie Ridge Care & Rehabilitation",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mediapolis, IA
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- Nancy Terese Engelhardt, DC
- Kimberly Krieger, NP
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- Mediapolis Care Facility Inc
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.