NPIMap

Organization Active NPI

Central Iowa Hospital Corporation

Doing business as Pathology Laboratory

  • Clinical Medical Laboratory
  • Ankeny, IA
National Provider Identifier
1962485136
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
16D0383397 Issued in IA
Legal business name
CENTRAL IOWA HOSPITAL CORPORATION
Doing business as
Pathology Laboratory
Practice address
3001 SE Convenience Blvd Unit 104
Ankeny, IA 50021-8503
Phone
(515) 241-8878
Fax
(515) 241-8857
NPI assigned
Nov 22, 2005
Last updated
Nov 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Authorized official

Name
David Stark
Title
Ceo
Phone
(515) 241-6507

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 16D0383397 IA Primary

Addresses

Primary practice location

3001 SE Convenience Blvd Unit 104
Ankeny, IA 50021-8503

Mailing address

3001 SE Convenience Blvd Unit 104
Ankeny, IA 50021-8503
Phone (515) 241-8878

Other practice location 1

1212 Pleasant St
Ste LL3
Des Moines, IA 50309-1414
Phone (515) 471-9310

Other practice location 2

3625 N Ankeny Blvd Ste G
Ankeny, IA 50023-4611
Phone (515) 965-4670

Other names 1

  • PATHOLOGY LABORATORY Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL http://www.pathologylab.org/contact-us.aspx

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040202001195 IA Part B Supplier - Independent Clinical Laboratory 1052229275 Practice locations: Ankeny, IA

Other NPIs with the same Medicare PAC ID 5

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

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0383397Pathology Laboratory3001 SE Convenience Blvd Unit 104, Ankeny, IA 50021AccreditationFeb 8, 2027
16D2124908Iowa Diagnostic Imaging & Procedure Center- Ankeny3625 N Ankeny Blvd, Suite H, Ankeny, IA 50023Certificate of waiverJan 26, 2027

National Provider Directory

National Provider Directory

Locations

3001 SE Convenience Blvd
Ste 104
Ankeny, IA 50021
Phone (515) 241-8878

3625 N Ankeny Blvd
Ste G
Ankeny, IA 50023
Phone (515) 965-4670

Ownership & related parties

All facility ownership & control disclosures 27

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

FacilityTypeRoleSince
Guthrie County HospitalGuthrie Center, IA, CCN 161314 Hospital Operational/Managerial Control Jan 1, 2014
Clarke County HospitalOsceola, IA, CCN 161348 Hospital Operational/Managerial Control Dec 1, 1987
Lucas County Health CenterChariton, IA, CCN 161341 Hospital Operational/Managerial Control Sep 1, 2015
Guthrie County HospitalGuthrie Center, IA, CCN 16Z314 Hospital Operational/Managerial Control Jan 1, 2014
Clarke County HospitalOsceola, IA, CCN 16Z348 Hospital Operational/Managerial Control Dec 1, 1987
Greater Regional Medical CenterCreston, IA, CCN 161365 Hospital Operational/Managerial Control Jul 1, 2017
Greater Regional Medical CenterCreston, IA, CCN 16Z365 Hospital Operational/Managerial Control Jul 1, 2017
Lucas County Health CenterChariton, IA, CCN 16Z341 Hospital Operational/Managerial Control Sep 1, 2015
Greene County Medical CenterJefferson, IA, CCN 161325 Hospital Operational/Managerial Control Jul 1, 2011
Unitypoint Health Des Moines Iowa Methodist Medical CenterDes Moines, IA, CCN 160082 Hospital Other Jun 22, 1982
Unitypoint Health Des Moines Iowa Methodist Medical CenterDes Moines, IA, CCN 16T082 Hospital Other Jun 22, 1982
Story County Medical CenterNevada, IA, CCN 161333 Hospital Operational/Managerial Control Feb 1, 2013
Story County Medical CenterNevada, IA, CCN 16Z333 Hospital Operational/Managerial Control Feb 1, 2013
Greene County Medical CenterJefferson, IA, CCN 16Z325 Hospital Operational/Managerial Control Jul 1, 2011
Unitypoint Health Des Moines Iowa Lutheran HospitalDes Moines, IA, CCN 16S082 Hospital Other Jun 22, 1982
Cedar Ridge VillageWest Des Moines, IA, CCN 165790 Skilled nursing facility Direct Ownership Interest (47.47%) Apr 1, 2021
Lenox Medical ClinicLenox, IA, CCN 163469 Rural health clinic Operational/Managerial Control Jul 1, 2017
Lucas County Health Center Medical ClinicChariton, IA, CCN 168560 Rural health clinic Operational/Managerial Control Sep 1, 2015
Story Medical Clinic - NevadaNevada, IA, CCN 168594 Rural health clinic Operational/Managerial Control Feb 1, 2013
Story Medical Clinic - MaxwellMaxwell, IA, CCN 168595 Rural health clinic Operational/Managerial Control Feb 1, 2013
Corning Medical ClinicCorning, IA, CCN 168636 Rural health clinic Operational/Managerial Control Jul 1, 2017
Mount Ayr Community Health ClinicMount Ayr, IA, CCN 168638 Rural health clinic Operational/Managerial Control Jul 1, 2017
Greene County Family MedicineJefferson, IA, CCN 168619 Rural health clinic Operational/Managerial Control Jul 1, 2011
Clarke County ClinicOsceola, IA, CCN 168618 Rural health clinic Operational/Managerial Control Dec 1, 1987
GCH ClinicsAdair, IA, CCN 168620 Rural health clinic Operational/Managerial Control Jan 1, 2014
GCH ClinicsStuart, IA, CCN 168632 Rural health clinic Operational/Managerial Control Jan 1, 2014
GCH ClinicsPanora, IA, CCN 168637 Rural health clinic Operational/Managerial Control Jan 1, 2014

Owned or controlled facilities with NPI records 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1962485136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 SE CONVENIENCE BLVD UNIT 104",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500218503",
            "telephone_number": "515-241-8878",
            "fax_number": "515-241-8857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 SE CONVENIENCE BLVD UNIT 104",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500218503",
            "telephone_number": "515-241-8878",
            "fax_number": "515-241-8857"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1212 Pleasant St",
            "address_2": "STE LL3",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503091414",
            "country_code": "US",
            "telephone_number": "515-471-9310",
            "fax_number": "515-471-9318",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3625 N Ankeny Blvd Ste G",
            "address_purpose": "LOCATION",
            "city": "Ankeny",
            "state": "IA",
            "postal_code": "500234611",
            "country_code": "US",
            "telephone_number": "515-965-4670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTRAL IOWA HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-22",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-241-6507"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IA",
            "license": "16D0383397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://www.pathologylab.org/contact-us.aspx",
            "affiliation": "N",
            "address_1": "3001 SE Convenience Blvd Unit 104",
            "city": "Ankeny",
            "state": "IA",
            "country_code": "US",
            "postal_code": "500218503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "PATHOLOGY LABORATORY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PATHOLOGY LABORATORY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ankeny, IA

Sources for this page

Verify at the official NPI Registry.