NPIMap

Organization Active NPI

Sioux Valley Memorial Hospital Association

Doing business as Cherokee Regional Clinic - Marcus

  • Family Medicine Physician
  • Marcus, IA
National Provider Identifier
1891791901
Registry record updated Jul 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Cherokee Regional Clinic - Marcus
Practice address
300 E Pine St
Marcus, IA 51035-7196
Phone
(712) 376-4600
Fax
(712) 376-4709
NPI assigned
Jun 23, 2005
Last updated
Jul 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2019

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

Authorized official

Name
Joan M Bierman
Title
Cfo
Phone
(712) 225-1505

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

300 E Pine St
Marcus, IA 51035-7196

Mailing address

300 Sioux Valley Dr
Cherokee, IA 51012-1205
Phone (712) 225-6265

Other identifiers 1

IdentifierTypeStateIssuer
0105742MedicaidIA

Other names 1

  • Cherokee Regional Clinic - Marcus Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040317001463 IA Part B Supplier - Clinic/Group Practice 4880501881 Receives reassigned benefits from 36 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aurelia, IA; Cherokee, IA; Marcus, IA
O20190703001017 IA Part A Provider - Rural Health Clinic 4880501881 Practice locations: Marcus, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891791901. Details of each certification follow.

Rural health clinic certification: CCN 168622

Legal name
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
Doing business as
MARCUS MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 22, 2019
Last certification
Jan 10, 2023
Ownership / control type
1B
Organization structure
CorporationNon-profit
Enrollment address
300 E Pine St
PO Box 587
Marcus, IA 51012-1205
Related CCNs
161362

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Tyler Gerstandt Individual Corporate OfficerCfo Apr 7, 2023
Kellen Ludvigson Individual Corporate Director Apr 12, 2021
Clay Leavitt Individual Corporate Director Apr 13, 2020
St. Luke's Health System, Inc. Organization, Sioux City, IA Non-profit Operational/Managerial Control Oct 1, 2013
Leslie William Todd Individual Corporate DirectorBoard Member Jan 1, 2019
Sheila Trapp Individual Corporate DirectorBoard Member Jan 1, 2019
Kerry Marie Hurd Individual Corporate Director Apr 12, 2022
Sarah Cook Individual Corporate DirectorBoard Member Jan 1, 2019
Gary W Jordan Individual Contracted Managing EmployeeCeo Jan 1, 2019
Brandon Henke Individual Corporate Director Apr 12, 2021

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Heartland Care Center IncMarcus, IA, CCN 165397 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jul 19, 2023
Jul 19, 2023
Jul 19, 2023

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 11

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562716800000",
    "number": "1891791901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SIOUX VALLEY DR",
            "city": "CHEROKEE",
            "state": "IA",
            "postal_code": "510121205",
            "telephone_number": "712-225-6265",
            "fax_number": "712-225-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E PINE ST",
            "city": "MARCUS",
            "state": "IA",
            "postal_code": "510357196",
            "telephone_number": "712-376-4600",
            "fax_number": "712-376-4709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2019-07-10",
        "status": "A",
        "authorized_official_last_name": "BIERMAN",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-225-1505"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105742",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cherokee Regional Clinic - Marcus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cherokee Regional Clinic - Marcus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marcus, IA

Sources for this page

Verify at the official NPI Registry.