NPIMap

Organization Active NPI

Siouxland Community Health Center

Doing business as Siouxland Community Health Center of Nebraska

  • Federally Qualified Health Center (FQHC)
  • South Sioux City, NE
National Provider Identifier
1912378480
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SIOUXLAND COMMUNITY HEALTH CENTER
Doing business as
Siouxland Community Health Center of Nebraska
Practice address
3410 Futures Dr
South Sioux City, NE 68776-3917
Phone
(712) 252-2477
NPI assigned
Oct 9, 2015
Last updated
Aug 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Authorized official

Name
Mark Donaldson
Title
Ceo
Phone
(712) 226-9010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3410 Futures Dr
South Sioux City, NE 68776-3917

Mailing address

1021 Nebraska St
Sioux City, IA 51105-1436
Phone (712) 252-2477

Other names 1

  • Siouxland Community Health Center of Nebraska Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151125001899 NE Part A Provider - Federally Qualified Health Center (FQHC) 9931099546 Practice locations: South Sioux City, NE
O20160205001783 NE Part B Supplier - Clinic/Group Practice 9931099546 Receives reassigned benefits from 25 practitioners
Practice locations: South Sioux City, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912378480. Details of each certification follow.

Federally qualified health center certification: CCN 281840

Legal name
SIOUXLAND COMMUNITY HEALTH CENTER
Doing business as
SIOUXLAND COMMUNITY HEALTH CENTER SOUTH SIOUX CITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 24, 2015
Last certification
Nov 24, 2015
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
3410 Futures Dr
South Sioux City, NE 68776-3917

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory

Locations

1021 Nebraska St
Ste 5410
Sioux City, IA 51105

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Dona J Prince Individual Other Nov 20, 2013
Jay L Rosenburg Individual Other Nov 20, 2014
William Suarez Individual Other Mar 1, 2007
Clara T Peterson Individual Corporate OfficerCfo Mar 29, 2025
W-2 Managing EmployeeCfo Mar 29, 2025
Operational/Managerial ControlCfo Mar 29, 2025
Mark Donaldson Individual 5% Or Greater Indirect Ownership InterestCeo Nov 11, 2024
Corporate OfficerCeo Nov 11, 2024
W-2 Managing EmployeeAd;Ceo Nov 11, 2024
Operational/Managerial ControlCeo Nov 11, 2024
Siouxland Community Health Center Organization, Sioux City, IA Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2015 100%
Operational/Managerial Control Dec 1, 2015

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1444348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785974400000",
    "number": "1912378480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 NEBRASKA ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051436",
            "telephone_number": "712-252-2477",
            "fax_number": "712-224-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 FUTURES DR",
            "city": "SOUTH SIOUX CITY",
            "state": "NE",
            "postal_code": "687763917",
            "telephone_number": "712-252-2477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUXLAND COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-09",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-226-9010"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Siouxland Community Health Center of Nebraska",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Sioux City, NE

Sources for this page

Verify at the official NPI Registry.