Active NPI
The Ambassador Sidney, Inc.
- Skilled Nursing Facility
- Sidney, IA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 360156
- Legal business name
- THE AMBASSADOR SIDNEY, INC.
- Practice address
- 115 Main St
Sidney, IA 51652-6069 - Phone
- (712) 374-2693
- Fax
- (712) 374-3064
- NPI assigned
- Jul 29, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Marcia Schroeder
- Title
- Chief Executive Officer
- Phone
- (402) 873-8507
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 360156 | IA | |
| Occupational Therapist | 225X00000X | 360156 | IA | |
| Speech-Language Pathologist | 235Z00000X | 360156 | IA | |
| Skilled Nursing Facility | 314000000X | 360156 | IA | Primary |
Addresses
Primary practice location
115 Main St
Sidney, IA 51652-6069
Mailing address
115 Main St
Sidney, IA 51652-6069
Phone (712) 374-2693
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0809640 | Medicaid | IA | |
| 165474 | Other | IA | WELLMARK BLUE CROSS & BLUE SHIELD |
Other names 1
- The Ambassador Sidney
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040503000218 | IA | Part A Provider - Skilled Nursing Facility | 9032107867 | Practice locations: Sidney, IA |
Skilled nursing facility certification: CCN 165474
- Legal name
- THE AMBASSADOR SIDNEY INC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 11, 2002
- Last certification
- Mar 20, 2025
- Beds
- 46
- Ownership / control type
- Corporation
- Multi-facility organization
- The Ambassador Holding Co.
- Organization structure
- Corporation
- Enrollment address
- 115 Main St
Sidney, IA 51652-6069 - Nursing home name
- THE AMBASSADOR SIDNEY INC
- Affiliated entity
- AMBASSADOR HEALTH
National Provider Directory
National Provider DirectoryLocations
115 Main St
Sidney, IA 51652
Phone (712) 374-2693
Ownership & related parties
All disclosed owners & managing parties 48
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jan 1, 2015 | ||
| The Ambassador Group Inc | Operational/Managerial Control | Feb 9, 1981 | 100% |
| Adp of the SNF | Feb 9, 1981 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Tyler J Juilfs | 5% Or Greater Indirect Ownership Interest | Dec 30, 2024 | 5% |
| Corporate Officer | Jul 1, 2021 | 5% | |
| Corporate Director | Jul 1, 2021 | 5% | |
| Adp of the SNF | Dec 30, 2024 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Sally Juilfs | 5% Or Greater Indirect Ownership Interest | Jun 5, 1985 | 44% |
| Corporate Officer | Jun 5, 1985 | ||
| Corporate Director | Jun 5, 1985 | ||
| Adp of the SNF | Jun 5, 1985 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Apr 16, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Aug 7, 2025 | ||
| Michael J Ourada | Operational/Managerial Control | Jan 1, 2024 | |
| Adp of the SNF | Jan 30, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Ambassador Holding Company | 5% Or Greater Direct Ownership Interest | Jun 5, 1985 | 100% |
| Adp of the SNF | Jun 5, 1985 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Apr 16, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Dora Long | Operational/Managerial Control | Jul 16, 2021 | |
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Apr 16, 2025 | ||
| First National Bank Omaha | 5% Or Greater Mortgage Interest | Jan 30, 2018 | 26% |
| Adp of the SNF | Apr 16, 2025 | ||
| Adp of the SNF | Apr 16, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Brent B Shanholtz | Operational/Managerial Control | Jan 1, 2013 | 100% |
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 1, 2016 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Timothy Juilfs | 5% Or Greater Indirect Ownership Interest | Jun 5, 1985 | 44% |
| Corporate Officer | Jun 5, 1985 | 50% | |
| Corporate Director | May 1, 2004 | 50% | |
| Adp of the SNF | Jun 5, 1985 | ||
| Jade Harrah | Operational/Managerial Control | Oct 10, 2022 | |
| Adp of the SNF | Jan 30, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 1, 2021 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 9, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Apr 16, 2025 | ||
| Adp of the SNF | Aug 7, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 | ||
| Adp of the SNF | Jul 20, 2025 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Hamburg, IA
- NPI 1427164789
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 3
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Lincoln, NE
- NPI 1811901259
Ambassador Holding Company, The Ambassador Group Inc
-
- Skilled Nursing Facility
- Nebraska City, NE
- NPI 1992771299
The Ambassador Group Inc
-
- Skilled Nursing Facility
- Omaha, NE
- NPI 1184638405
Ambassador Holding Company, The Ambassador Group Inc
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
Care Compare: Nursing home
Medicare Care Compare- Listed as
- The Ambassador Sidney Inc
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Nov 11, 2002
- Medicare certification status
- Active
- Certified beds
- 46
- Chain
- Ambassador Health
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D0881604 | Ambassador Sidney, the | Certificate of waiver | Jan 11, 2028 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154131200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1404777600000",
"number": "1902811276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 MAIN ST",
"city": "SIDNEY",
"state": "IA",
"postal_code": "516526069",
"telephone_number": "712-374-2693",
"fax_number": "712-374-3064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 MAIN ST",
"city": "SIDNEY",
"state": "IA",
"postal_code": "516526069",
"telephone_number": "712-374-2693",
"fax_number": "712-374-3064"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE AMBASSADOR SIDNEY, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-29",
"last_updated": "2014-07-08",
"status": "A",
"authorized_official_last_name": "SCHROEDER",
"authorized_official_first_name": "MARCIA",
"authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "402-873-8507",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "IA",
"license": "360156",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "IA",
"license": "360156",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "IA",
"license": "360156",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IA",
"license": "360156",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0809640",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK BLUE CROSS & BLUE SHIELD",
"identifier": "165474",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "The Ambassador Sidney",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Sidney, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; 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.