NPIMap

Organization Active NPI

Medical Clinic LLC

  • Rural Health Clinic/Center
  • Hamburg, IA
National Provider Identifier
1972575595
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEDICAL CLINIC LLC
Practice address
1219 Main St
Hamburg, IA 51640-1300
Phone
(712) 382-2626
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Authorized official

Name
Cristin A Hendrickson
Title
Ceo
Phone
(712) 382-1515

Specialties & licenses 1

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

Addresses

Primary practice location

1219 Main St
Hamburg, IA 51640-1300

Mailing address

1219 Main St
Hamburg, IA 51640-1300
Phone (712) 382-2626

Other identifiers 2

IdentifierTypeStateIssuer
0018507MedicaidIA
01850OtherWELLMARK BC/BS OF IA

Other names 1

  • MEDICAL CLINIC P.C. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071003000602 IA Part B Supplier - Clinic/Group Practice 5395634216 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tabor, IA; Sidney, IA; Hamburg, IA
O20100910000422 IA Part A Provider - Rural Health Clinic 5395634216 Practice locations: Hamburg, IA

Rural health clinic certification: CCN 163834

Legal name
MEDICAL CLINIC LLC
Doing business as
MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 31, 1993
Last certification
Feb 22, 2021
Ownership / control type
1B
Organization structure
LLCNon-profit
Enrollment address
1219 Main St
Hamburg, IA 51640-1300

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Cristin a Hendrickson Individual Contracted Managing EmployeeCeo Dec 31, 2023
Corporate OfficerCeo Dec 31, 2023
Operational/Managerial ControlCeo Dec 31, 2023
Michael J Ourada Individual W-2 Managing EmployeeMD; Dec 31, 2023
Operational/Managerial ControlMedical Director Dec 31, 2023
Community Hospital Inc Organization, Hamburg, IA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 31, 2023 100%
Operational/Managerial Control Dec 31, 2023
Sara M Ward Individual W-2 Managing EmployeeAd;Practice Manager Jan 1, 2023
Operational/Managerial ControlPractice Manager Jan 1, 2023

Owners & managing parties with NPI records 4

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1972575595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 MAIN ST",
            "city": "HAMBURG",
            "state": "IA",
            "postal_code": "516401300",
            "telephone_number": "712-382-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 MAIN ST",
            "city": "HAMBURG",
            "state": "IA",
            "postal_code": "516401300",
            "telephone_number": "712-382-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "CRISTIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-382-1515"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018507",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BC/BS OF IA",
            "identifier": "01850",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL CLINIC P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Hamburg, IA

Sources for this page

Verify at the official NPI Registry.