NPIMap

Organization Active NPI

Guttenberg Municipal Hospital

Doing business as Cornerstone Family Practice

  • Rural Health Clinic/Center
  • Guttenberg, IA
National Provider Identifier
1972855286
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GUTTENBERG MUNICIPAL HOSPITAL
Doing business as
Cornerstone Family Practice
Practice address
200 Main St
Guttenberg, IA 52052-9108
Phone
(563) 252-1121
Fax
(563) 252-5547
NPI assigned
Oct 10, 2012
Last updated
Oct 24, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GUTTENBERG MUNICIPAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Authorized official

Name
Susan Stagman, RHIT
Title
Credentialing Specialist
Phone
(563) 252-1121

Specialties & licenses 1

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

Addresses

Primary practice location

200 Main St
Guttenberg, IA 52052-9108

Mailing address

PO Box 550
Guttenberg, IA 52052-0550
Phone (563) 252-1121

Other names 1

  • Cornerstone Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121121000052 IA Part A Provider - Rural Health Clinic 6901709476 Practice locations: Guttenberg, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972855286. Details of each certification follow.

Rural health clinic certification: CCN 168552

Legal name
GUTTENBERG MUNICIPAL HOSPITAL
Doing business as
CORNERSTONE FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 1, 2012
Last certification
Sep 8, 2021
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
200 Main St
Guttenberg, IA 52052-9108
Related CCNs
161312

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Guttenberg Mu7 organizations share this tax ID, including this one
Part of
Guttenberg Mu

Other organizations with this tax ID 6

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

Locations

200 Main St
#3
Guttenberg, IA 52052

200 Main St
Ste 2
Guttenberg, IA 52052

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
City of Guttenberg Organization, Guttenberg, IA 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Janice Lee Andregg Individual Corporate OfficerBoard Trustee Jan 1, 2016 20%
Robin S Esmann Individual W-2 Managing EmployeeDirector of Performance Excellence Dec 15, 2017
Karen Lynn Merrick Individual Corporate OfficerBoard Trustee Jan 1, 2016 20%
Timothy J Ahlers Individual Contracted Managing EmployeeCeo Apr 1, 2019
Stephanie Radabaugh Individual Corporate Officer Jan 1, 2022
William L Allyn Individual Corporate OfficerBoard Trustee Jan 1, 2012 20%
Mercy Health Network Inc Organization, Clive, IA Corporation Operational/Managerial Control Oct 1, 2017 100%
Guttenberg Municipal Hospital Organization, Guttenberg, IA 5% Or Greater Direct Ownership Interest Dec 1, 2012 100%
Operational/Managerial Control Dec 1, 2012 100%
Susan a Osterhaus Individual Corporate OfficerBoard Trustee Jan 1, 2013 20%

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Cornerstone Family PracticeEdgewood, IA, CCN 168553 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 1, 2012
Dec 1, 2012
Cornerstone Family PracticeGarnavillo, IA, CCN 168550 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 1, 2012
Dec 1, 2012

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 98

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

View all 98

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1972855286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "GUTTENBERG",
            "state": "IA",
            "postal_code": "520520550",
            "telephone_number": "563-252-1121",
            "fax_number": "563-252-5547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MAIN ST",
            "city": "GUTTENBERG",
            "state": "IA",
            "postal_code": "520529108",
            "telephone_number": "563-252-1121",
            "fax_number": "563-252-5547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUTTENBERG MUNICIPAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUTTENBERG MUNICIPAL HOSPITAL",
        "enumeration_date": "2012-10-10",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "STAGMAN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "563-252-1121",
        "authorized_official_credential": "RHIT"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornerstone Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Guttenberg, IA

Sources for this page

Verify at the official NPI Registry.