NPIMap

Organization Active NPI

Iowa Specialty Hospital - Clarion

Doing business as Fort Dodge Clinic

  • Rural Health Clinic/Center
  • Fort Dodge, IA
National Provider Identifier
1922578202
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
IOWA SPECIALTY HOSPITAL - CLARION
Doing business as
Fort Dodge Clinic
Practice address
2700 1St Ave S Ste 100
Fort Dodge, IA 50501-4300
Phone
(515) 955-6767
Fax
(515) 576-8581
NPI assigned
Nov 29, 2018
Last updated
Nov 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Authorized official

Name
Steve Simonin
Title
Ceo
Phone
(515) 532-9333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2700 1St Ave S Ste 100
Fort Dodge, IA 50501-4300

Mailing address

1316 S Main St
Clarion, IA 50525-2019
Phone (515) 532-2811

Other names 1

  • Fort Dodge Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200825002561 IA Part A Provider - Rural Health Clinic 3375451347 Practice locations: Fort Dodge, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922578202. Details of each certification follow.

Rural health clinic certification: CCN 168644

Legal name
IOWA SPECIALTY HOSPITAL- CLARION
Doing business as
FORT DODGE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 22, 2020
Last certification
Sep 11, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
2700 1St Ave S
Ste 100
Fort Dodge, IA 50501-4300
Related CCNs
161302

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Iowa Specialty Hospital- Clarion22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Gregory C Polzin Individual Corporate Director Mar 19, 2014
Ken W Stoakes Individual Corporate Director Nov 19, 2013
Iowa Specialty Hospital- Clarion Organization, Clarion, IA Non-profit Operational/Managerial Control Jan 1, 2000 100%
Gerald Boyington Individual Corporate Director Jun 28, 2018
Katrina Stecher Individual Corporate Director Feb 13, 2007
Judith a Ritter Individual Corporate Director Mar 19, 2014
Missy Brannick Individual W-2 Managing Employee Oct 11, 2017
Lisa Hagie Individual Corporate Director Oct 11, 2017
Sue Martin Individual Corporate Director Mar 19, 2014
Steven J Simonin Individual Corporate Officer Mar 19, 2014
Kelly J Leu Individual W-2 Managing Employee Oct 11, 2017

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Iowa Specialty Hospital- ClarionClarion, IA, CCN 161302 Hospital Operational/Managerial Control (100%) Jan 1, 2000
Iowa Specialty Hospital-ClarionClarion, IA, CCN 16Z302 Hospital Operational/Managerial Control (100%) Jan 1, 2000

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

NPI Registry JSON

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543449600000",
    "number": "1922578202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1316 S MAIN ST",
            "city": "CLARION",
            "state": "IA",
            "postal_code": "505252019",
            "telephone_number": "515-532-2811",
            "fax_number": "515-532-9336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 1ST AVE S STE 100",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505014300",
            "telephone_number": "515-955-6767",
            "fax_number": "515-576-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IOWA SPECIALTY HOSPITAL - CLARION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-29",
        "last_updated": "2018-11-29",
        "status": "A",
        "authorized_official_last_name": "SIMONIN",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-532-9333"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Dodge Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Dodge, IA

Sources for this page

Verify at the official NPI Registry.