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Central Iowa Hospital Corporation

Organization Active NPI Clinical Medical Laboratory · Ankeny, IA

NPI 1962485136 · NPPES record last updated Nov 8, 2022

Key facts

NPI
1962485136
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Medical Laboratory 291U00000X
License
16D0383397 (IA)
Legal business name
CENTRAL IOWA HOSPITAL CORPORATION
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
Organization subpart
No

Authorized official

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

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

Other NPIs with the same Medicare PAC ID 5

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

Practitioners 233

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

View all 233

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
16D0383397Pathology Laboratory
3001 SE Convenience Blvd Unit 104, Ankeny, IA 50021		AccreditationFeb 8, 2027
16D2124908Iowa Diagnostic Imaging & Procedure Center- Ankeny
3625 N Ankeny Blvd, Suite H, Ankeny, IA 50023		Certificate of waiverJan 26, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

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 Hospital
Guthrie Center, IA · CCN 161314		 Hospital Operational/Managerial Control Jan 1, 2014
Clarke County Hospital
Osceola, IA · CCN 161348		 Hospital Operational/Managerial Control Dec 1, 1987
Lucas County Health Center
Chariton, IA · CCN 161341		 Hospital Operational/Managerial Control Sep 1, 2015
Guthrie County Hospital
Guthrie Center, IA · CCN 16Z314		 Hospital Operational/Managerial Control Jan 1, 2014
Clarke County Hospital
Osceola, IA · CCN 16Z348		 Hospital Operational/Managerial Control Dec 1, 1987
Greater Regional Medical Center
Creston, IA · CCN 161365		 Hospital Operational/Managerial Control Jul 1, 2017
Greater Regional Medical Center
Creston, IA · CCN 16Z365		 Hospital Operational/Managerial Control Jul 1, 2017
Lucas County Health Center
Chariton, IA · CCN 16Z341		 Hospital Operational/Managerial Control Sep 1, 2015
Greene County Medical Center
Jefferson, IA · CCN 161325		 Hospital Operational/Managerial Control Jul 1, 2011
Unitypoint Health Des Moines Iowa Methodist Medical Center
Des Moines, IA · CCN 160082		 Hospital Other Jun 22, 1982
Unitypoint Health Des Moines Iowa Methodist Medical Center
Des Moines, IA · CCN 16T082		 Hospital Other Jun 22, 1982
Story County Medical Center
Nevada, IA · CCN 161333		 Hospital Operational/Managerial Control Feb 1, 2013
Story County Medical Center
Nevada, IA · CCN 16Z333		 Hospital Operational/Managerial Control Feb 1, 2013
Greene County Medical Center
Jefferson, IA · CCN 16Z325		 Hospital Operational/Managerial Control Jul 1, 2011
Unitypoint Health Des Moines Iowa Lutheran Hospital
Des Moines, IA · CCN 16S082		 Hospital Other Jun 22, 1982
Cedar Ridge Village
West Des Moines, IA · CCN 165790		 Skilled nursing facility Direct Ownership Interest (47.47%) Apr 1, 2021
Lenox Medical Clinic
Lenox, IA · CCN 163469		 Rural health clinic Operational/Managerial Control Jul 1, 2017
Lucas County Health Center Medical Clinic
Chariton, IA · CCN 168560		 Rural health clinic Operational/Managerial Control Sep 1, 2015
Story Medical Clinic - Nevada
Nevada, IA · CCN 168594		 Rural health clinic Operational/Managerial Control Feb 1, 2013
Story Medical Clinic - Maxwell
Maxwell, IA · CCN 168595		 Rural health clinic Operational/Managerial Control Feb 1, 2013
Corning Medical Clinic
Corning, IA · CCN 168636		 Rural health clinic Operational/Managerial Control Jul 1, 2017
Mount Ayr Community Health Clinic
Mount Ayr, IA · CCN 168638		 Rural health clinic Operational/Managerial Control Jul 1, 2017
Greene County Family Medicine
Jefferson, IA · CCN 168619		 Rural health clinic Operational/Managerial Control Jul 1, 2011
Clarke County Clinic
Osceola, IA · CCN 168618		 Rural health clinic Operational/Managerial Control Dec 1, 1987
GCH Clinics
Adair, IA · CCN 168620		 Rural health clinic Operational/Managerial Control Jan 1, 2014
GCH Clinics
Stuart, IA · CCN 168632		 Rural health clinic Operational/Managerial Control Jan 1, 2014
GCH Clinics
Panora, IA · CCN 168637		 Rural health clinic Operational/Managerial Control Jan 1, 2014

Medicare enrollment records

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

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

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
0198945MedicaidIA

Other names

  • PATHOLOGY LABORATORY Doing business as

Electronic endpoints

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 8, 2022.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0198945",
            "state": "IA"
        }
    ],
    "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

All providers in Ankeny, IA · Clinical Medical Laboratory in Iowa

Sources for this page

Verify at the official NPI Registry.