NPIMap

Organization Active NPI

Jefferson County Hospital

Doing business as JCH Professional Clinic

  • Surgery Physician
  • Fairfield, IA
National Provider Identifier
1972771384
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
22423 Issued in IA
Legal business name
JEFFERSON COUNTY HOSPITAL
Doing business as
JCH Professional Clinic
Jefferson County Health Center
Practice address
2000 S Main St
Fairfield, IA 52556-9572
Phone
(641) 469-4204
Fax
(641) 469-4208
NPI assigned
Feb 19, 2008
Last updated
May 30, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
JEFFERSON COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 30, 2025

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

Authorized official

Name
Brent Robert Feickert
Title
Chief Financial Officer
Phone
(641) 469-4304

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 37410 IA
Surgery Physician 208600000X 22423 IA Primary

Addresses

Primary practice location

2000 S Main St
Fairfield, IA 52556-9572

Mailing address

2000 S Main St
Fairfield, IA 52556-9572
Phone (641) 469-4204

Other identifiers 2

IdentifierTypeStateIssuer
33819OtherIAWELLMARK BC/BS OF IA
0468850MedicaidIA

Other names 2

  • JCH Professional Clinic Doing business as
  • Jefferson County Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031223000606 IA Part B Supplier - Clinic/Group Practice 9335059575 Receives reassigned benefits from 86 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fairfield, IA; Richland, IA

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Jefferson Co Hosp

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1972771384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 S MAIN ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525569572",
            "telephone_number": "641-469-4204",
            "fax_number": "641-469-4208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S MAIN ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525569572",
            "telephone_number": "641-469-4204",
            "fax_number": "641-469-4208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFERSON COUNTY HOSPITAL",
        "enumeration_date": "2008-02-19",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A",
        "authorized_official_last_name": "FEICKERT",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "641-469-4304"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IA",
            "license": "37410",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "22423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BC/BS OF IA",
            "identifier": "33819",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0468850",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JCH Professional Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JCH Professional Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jefferson County Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.