NPIMap

Organization Active NPI

Palo Alto County Hospital

Doing business as Family Practice Clinic-West Bend

  • Rural Health Clinic/Center
  • West Bend, IA
National Provider Identifier
1962572776
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PALO ALTO COUNTY HOSPITAL
Doing business as
Family Practice Clinic-West Bend
Practice address
107 W Division St
West Bend, IA 50597-7738
Phone
(515) 887-7891
NPI assigned
Nov 9, 2006
Last updated
Dec 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Authorized official

Name
Desiree A Einsweiler
Title
Ceo
Phone
(712) 852-5500

Specialties & licenses 1

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

Addresses

Primary practice location

107 W Division St
West Bend, IA 50597-7738

Mailing address

3201 1St St
Emmetsburg, IA 50536-2516
Phone (712) 852-5500

Other identifiers 2

IdentifierTypeStateIssuer
0634840MedicaidIA
63417OtherIAWELLMARK

Other names 1

  • FAMILY PRACTICE CLINIC-WEST BEND Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address HIM@pamhn.cernerdirect.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030210000035 IA Part A Provider - Rural Health Clinic 4486563061 Practice locations: West Bend, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962572776. Details of each certification follow.

Rural health clinic certification: CCN 163417

Legal name
PALO ALTO COUNTY HOSPITAL
Doing business as
FAMILY PRACTICE CLINIC WEST BEND
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 12, 1994
Last certification
Oct 11, 2022
Ownership / control type
1B
Organization structure
GovernmentNon-profit
Enrollment address
107 W Division St
West Bend, IA 50597-7738
Related CCNs
161357

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Palo Alto County Hospit9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

107 W Division St
West Bend, IA 50597
Phone (515) 887-7881

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Coleen R Ruddy Individual W-2 Managing Employee Oct 15, 2008
Cynthia Magee Individual Corporate Director Jan 23, 2019
Terry Naig Individual Corporate Director Aug 22, 2012
Dawn Schmidt Individual Corporate Director Oct 15, 2008
Palo Alto County Hospital Organization, Emmetsburg, IA Operational/Managerial Control Sep 12, 1994
Collette Johnson Individual Corporate Director Jun 20, 2016
W-2 Managing Employee Jun 20, 2016
Operational/Managerial Control Jun 20, 2016
Melanie Flynn Individual Corporate Director Jan 27, 2021
Richard Brennan Individual Corporate Director Feb 20, 2019
Jana Harris Individual Corporate Director Jan 23, 2019
Jonathan Dean Moe Individual Contracted Managing Employee Feb 1, 2021
Corporate Officer Feb 1, 2021
Operational/Managerial Control Feb 1, 2021
Burt J. Hobart Individual Corporate Director Oct 15, 2008

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Palo Alto County HospitalEmmetsburg, IA, CCN 161357 Hospital Operational/Managerial Control Jan 2, 2013
Palo Alto County HospitalEmmetsburg, IA, CCN 16Z357 Hospital Operational/Managerial Control Jan 2, 2008
Palo Alto Community Health ServicesEmmetsburg, IA, CCN 167049 Home health agency Operational/Managerial Control Jan 10, 2012
Hospice of Palo Alto CountyEmmetsburg, IA, CCN 161530 Hospice Operational/Managerial Control Sep 9, 1993

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1962572776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 1ST ST",
            "city": "EMMETSBURG",
            "state": "IA",
            "postal_code": "505362516",
            "telephone_number": "712-852-5500",
            "fax_number": "712-852-5409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 W DIVISION ST",
            "city": "WEST BEND",
            "state": "IA",
            "postal_code": "505977738",
            "telephone_number": "515-887-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALO ALTO COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "EINSWEILER",
        "authorized_official_first_name": "DESIREE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-852-5500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0634840",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "63417",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "HIM@pamhn.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "PACHS Direct Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3201 1st St",
            "city": "Emmetsburg",
            "state": "IA",
            "country_code": "US",
            "postal_code": "505362516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "FAMILY PRACTICE CLINIC-WEST BEND",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY PRACTICE CLINIC-WEST BEND",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Bend, IA

Sources for this page

Verify at the official NPI Registry.