NPIMap

Ottumwa Health Group LLC

Organization Active NPI Rural Health Clinic/Center · Eddyville, IA

NPI 1962023663 · NPPES record last updated Sep 26, 2024

Key facts

NPI
1962023663
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
OTTUMWA HEALTH GROUP LLC
Practice address
107 N 3Rd St
Eddyville, IA 52553-7709
Phone
(641) 969-5212
NPI assigned
May 4, 2020
Organization subpart
No

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Other NPIs on the same Medicare enrollment 5

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 4

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

Facilities with the same owner 19

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

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0977193Ottumwa Health Group, LLC
107 North Third Street, Eddyville, IA 52553		Certificate of waiverAug 21, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IA

Rural health clinic certification: CCN 168977

Legal name
OTTUMWA HEALTH GROUP LLC
Doing business as
THE EDDYVILLE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 29, 2020
Last certification
Oct 29, 2020
Ownership / control type
1B
Organization structure
LLC · Proprietary
Enrollment address
107 N 3Rd St
Eddyville, IA 52553-7709

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Pamela Kane
Individual 		Corporate Officer
Vice President		 Aug 9, 2022
DSB Acquisition LLC
Organization · Brentwood, TN
LLC 		5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Laura C Hinson
Individual 		Corporate Officer
Chief Financial Officer		 Mar 12, 2025
Ottumwa Physicians LLC
Organization · Brentwood, TN
LLC 		5% Or Greater Direct Ownership Interest Jun 1, 2023 100%
Lifepoint Health Inc
Organization · Brentwood, TN
Corporation 		5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Charlotte E Lawrence
Individual 		Corporate Officer
Secretary		 Jun 1, 2023
Regionalcare Hospital Partners LLC
Organization · Brentwood, TN
LLC 		5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
RCHP-Ottumwa Holdings Inc
Organization · Brentwood, TN
Corporation 		5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Elliott Brown
Individual 		Corporate Officer
Senior Vice President and Treasurer		 Apr 2, 2026
RCHP LLC
Organization · Brentwood, TN
LLC 		5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Klaus Michael Boel
Individual 		Corporate Officer
President		 Aug 19, 2024
W-2 Managing Employee Aug 19, 2024
Christopher J Monte
Individual 		Corporate Officer
Vice President		 Jun 1, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100927001257 IA Part B Supplier - Clinic/Group Practice 3971629924 Receives reassigned benefits from 86 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sigourney, IA; Centerville, IA; Ottumwa, IA; Fairfield, IA; Eddyville, IA; Bloomfield, IA
O20200612000646 IA Part a Provider - Rural Health Clinic 3971629924 Practice locations: Eddyville, IA

National Provider Directory

Tax ID family
Ottumwa Health Group LLC (5 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

107 N 3Rd St
Eddyville, IA 52553-7709

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000

Other names

  • The Eddyville Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 26, 2024.

{
    "created_epoch": "1588550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1962023663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N 3RD ST",
            "city": "EDDYVILLE",
            "state": "IA",
            "postal_code": "525537709",
            "telephone_number": "641-969-5212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTUMWA HEALTH GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-04",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Eddyville Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Eddyville Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eddyville, IA

All providers in Eddyville, IA · Rural Health Clinic/Center in Iowa

Sources for this page

Verify at the official NPI Registry.