NPIMap

Organization Active NPI

Madison County Memorial Hospital

Doing business as Health Trust Physicians Clinic

  • Rural Health Clinic/Center
  • Winterset, IA
National Provider Identifier
1962567990
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MADISON COUNTY MEMORIAL HOSPITAL
Doing business as
Health Trust Physicians Clinic
Practice address
300 W Hutchings St Ste 100&110
Winterset, IA 50273-2109
Phone
(515) 462-2950
Fax
(515) 462-5213
NPI assigned
Dec 27, 2006
Last updated
Dec 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MADISON COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Mrs. Marcia L Hendricks
Title
Ceo
Phone
(515) 462-2373

Specialties & licenses 1

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

Addresses

Primary practice location

300 W Hutchings St Ste 100&110
Winterset, IA 50273-2109

Mailing address

300 W Hutchings St
Winterset, IA 50273-2104
Phone (515) 462-2373

Other identifiers 2

IdentifierTypeStateIssuer
0634105MedicaidIA
63410OtherIABCBS

Other names 1

  • Health Trust Physicians Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030919000023 IA Part A Provider - Rural Health Clinic 6002727179 Practice locations: Winterset, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962567990. Details of each certification follow.

Rural health clinic certification: CCN 163410

Legal name
MADISON COUNTY MEMORIAL HOSPITAL
Doing business as
HEALTH TRUST PHYSICIANS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 18, 1994
Last certification
May 21, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
300 W Hutchings St
Ste 100&110
Winterset, IA 50273-2109
Related CCNs
161326

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Madison County Health Care System6 organizations share this tax ID, including this one
Part of
Madison County Health Care System

Other organizations with this tax ID 5

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

Locations

300 W Hutchings St
Ste 100110
Winterset, IA 50273
Phone (515) 462-2950

Ownership & related parties

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
Elisa L Perry Individual W-2 Managing EmployeeAd;Clinic Director Jun 29, 2017
Operational/Managerial ControlClinic Director Jun 29, 2017
Jared McDonald Individual Corporate Officer Sep 26, 2019
Corporate Director May 28, 2015
Sarah C. Nigg Individual Corporate Director May 9, 2024
Brian K Gibson Individual Corporate Officer Dec 1, 2022
Corporate Director Dec 14, 2021
Mercy Health Network Inc Organization, Clive, IA Corporation, Management services company, Non-profit Operational/Managerial Control Nov 1, 2012
Julie R Plant Individual Corporate Director Jan 22, 2026
Jacque Mohs Individual Corporate Officer Jan 1, 2021
Corporate Director Jul 23, 2015
Sharon Carlson Individual Corporate Director Jan 26, 2017
Audra C Ford Individual Corporate OfficerCfo Sep 2, 2024
W-2 Managing EmployeeCfo Sep 2, 2024
Operational/Managerial ControlCfo Sep 2, 2024
Gary R Van Dyke Individual Corporate Director Jan 1, 2025
Marcia L. Hendricks Individual Contracted Managing EmployeeCeo Sep 8, 2003
Corporate OfficerCeo Jun 23, 2016
Operational/Managerial ControlCeo Sep 8, 2003
Kevin V Deregnier Individual W-2 Managing EmployeeMD; Nov 14, 2025
Operational/Managerial ControlMedical Director Nov 14, 2025

Owners & managing parties with NPI records 1

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

Facilities with the same owner 98

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

View all 98

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1962567990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W HUTCHINGS ST",
            "city": "WINTERSET",
            "state": "IA",
            "postal_code": "502732104",
            "telephone_number": "515-462-2373",
            "fax_number": "515-462-5213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W HUTCHINGS ST STE 100&110",
            "city": "WINTERSET",
            "state": "IA",
            "postal_code": "502732109",
            "telephone_number": "515-462-2950",
            "fax_number": "515-462-5213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MADISON COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-12-27",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-462-2373",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0634105",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "63410",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Trust Physicians Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winterset, IA

Sources for this page

Verify at the official NPI Registry.