NPIMap

Organization Active NPI

Pella Regional Health Center

Doing business as Pella Regional Health Center Pharmacy

  • Community/Retail Pharmacy
  • Pella, IA
National Provider Identifier
1932599404
Registry record updated Aug 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1520 Issued in IA
Legal business name
PELLA REGIONAL HEALTH CENTER
Doing business as
Pella Regional Health Center Pharmacy
Practice address
802 Washington St
Pella, IA 50219-1525
Phone
(641) 628-1612
Fax
(641) 620-0021
NPI assigned
Feb 4, 2015
Last updated
Aug 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2016

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

Authorized official

Name
Tony Linkmeyer, RPH
Title
Chief of Ancillary Services/Ao
Phone
(641) 628-1612

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 1520 IA Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

802 Washington St
Pella, IA 50219-1525

Mailing address

802 Washington St
Pella, IA 50219-1525
Phone (641) 628-1612

Other identifiers 2

IdentifierTypeStateIssuer
1932599404MedicaidIA
2150439OtherPK

Other names 1

  • Pella Regional Health Center Pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151216000449 IA DME Supplier - Pharmacy 9931005873 Practice locations: Pella, IA
O20160516000329 IA Part B Supplier - Mass Immunization (Roster Biller Only) 9931005873 1 other NPI on this enrollment
Practice locations: Pella, IA

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 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Pella Regional Health Center Pharma802 Washington Street, Pella, IA 50219-1525(641) 628-1612 Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Nebulizer Equipment and/or Supplies Accepts assignmentParticipating since Feb 1, 2004

National Provider Directory

National Provider Directory
Tax ID family
Pella Medical Clinic13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Pella Regional Health CenterPella, IA, CCN 161367 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 29, 2013
Aug 29, 2013
Pella Regional Health CenterPella, IA, CCN 16Z367 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 29, 2013
Nov 15, 2007
Pella Regional Home Health AgencyPella, IA, CCN 167220 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 21, 2007
Jan 1, 1994
Hospice of Pella, the Comfort HousePella, IA, CCN 161538 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 19, 1996
Sep 19, 1996
Sully Family Health CenterSully, IA, CCN 163455 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 1996
Jan 1, 1996
Ottumwa Medical ClinicOttumwa, IA, CCN 168562 Rural health clinic Operational/Managerial Control (100%) Aug 1, 2012
Prairie City Medical ClinicPrairie City, IA, CCN 168660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Security Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2017
Jul 1, 2017
Jul 1, 2017

Owned or controlled facilities with NPI records 7

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

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": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471824000000",
    "number": "1932599404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 WASHINGTON ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191525",
            "telephone_number": "641-628-1612",
            "fax_number": "641-620-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 WASHINGTON ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191525",
            "telephone_number": "641-628-1612",
            "fax_number": "641-620-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELLA REGIONAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "last_updated": "2016-08-22",
        "status": "A",
        "authorized_official_last_name": "LINKMEYER",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CHIEF OF ANCILLARY SERVICES/AO",
        "authorized_official_telephone_number": "641-628-1612",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "1520",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932599404",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2150439",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pella Regional Health Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pella, IA

Sources for this page

Verify at the official NPI Registry.