NPIMap

Organization Active NPI

Ida County Iowa Community Hospital

  • Rural Health Clinic/Center
  • Odebolt, IA
National Provider Identifier
1982006359
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
470061H Issued in IA
Legal business name
IDA COUNTY IOWA COMMUNITY HOSPITAL
Practice address
300 S Maple St
Odebolt, IA 51458-7714
Phone
(712) 668-2232
NPI assigned
Sep 17, 2014
Organization subpart
Yes
Parent organization
IDA COUNTY IOWA COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Authorized official

Name
Joni G. Schumann
Title
Cfo
Phone
(712) 364-7225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 470061H IA Primary

Addresses

Primary practice location

300 S Maple St
Odebolt, IA 51458-7714

Mailing address

701 E 2ND St
Ida Grove, IA 51445-1666
Phone (712) 364-3311

Other identifiers 1

IdentifierTypeStateIssuer
IB1500OtherIAMEDICARE PTAN

Other names 1

  • Horn Physicians Clinic Odebolt Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141107001827 IA Part A Provider - Rural Health Clinic 9537070826 Practice locations: Odebolt, IA

Rural health clinic certification: CCN 168565

Legal name
IDA COUNTY IOWA COMMUNITY HOSPITAL
Doing business as
HORN PHYSICIANS CLINIC ODEBOLT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 11, 2015
Last certification
Apr 9, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 25, 1960 in IA
Enrollment address
300 S Maple St
Odebolt, IA 51458-7714
Related CCNs
161354

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

Other NPIs with the same Medicare PAC ID 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0920429Horn Physicians Clinic - Odebolt300 South Maple, Odebolt, IA 51458ComplianceSep 18, 2026

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hosp Pulmonhor9 organizations share this tax ID, including this one
Part of
Memorial Hosp Pulmonhor

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Shannon M Fox Individual Corporate OfficerCfo May 1, 2024
W-2 Managing EmployeeCfo May 1, 2024
Operational/Managerial ControlCfo May 1, 2024
Albert M Veltri Individual W-2 Managing EmployeeMD; May 11, 2015
Operational/Managerial ControlMedical Director May 11, 2015
Denise D Redenius Individual Corporate Director Apr 24, 2023
Michelle K Weber Individual W-2 Managing EmployeeChief Primary Clinics Officer Oct 1, 2009
Operational/Managerial ControlChief Primary Clinics Officer Oct 1, 2009
Kristeen R Gunderson Individual Corporate Director May 23, 2022
Cole Boger Individual Corporate Officer May 23, 2022
Corporate Director Jun 22, 2020
David Forbes Individual Corporate Director Apr 23, 2018
Robert D Paulsen Individual Corporate Director Apr 25, 2022
Emily Lange Individual Corporate OfficerCco/Cno Dec 6, 2020
W-2 Managing EmployeeCco/Cno Dec 6, 2020
Operational/Managerial ControlCco/Cno Dec 6, 2020
Vance Lundell Individual Corporate Officer May 1, 2024
Corporate Director Apr 23, 2018
Kelli Boyle Individual Corporate Officer May 23, 2022
Corporate Director Apr 23, 2018
Glen Winekauf Individual Corporate OfficerCeo Sep 14, 2017
W-2 Managing EmployeeCeo Sep 14, 2017
Operational/Managerial ControlCeo Sep 14, 2017
Jean Burns Individual Corporate Officer Apr 23, 2018
Corporate Director Apr 25, 2016
Christina Kjar Hanson Individual Corporate Director Apr 22, 2019

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1982006359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E 2ND ST",
            "city": "IDA GROVE",
            "state": "IA",
            "postal_code": "514451666",
            "telephone_number": "712-364-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S MAPLE ST",
            "city": "ODEBOLT",
            "state": "IA",
            "postal_code": "514587714",
            "telephone_number": "712-668-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDA COUNTY IOWA COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IDA COUNTY IOWA COMMUNITY HOSPITAL",
        "enumeration_date": "2014-09-17",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "SCHUMANN",
        "authorized_official_first_name": "JONI",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-364-7225"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IA",
            "license": "470061H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IB1500",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Horn Physicians Clinic Odebolt",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Horn Physicians Clinic Odebolt",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Odebolt, IA

Sources for this page

Verify at the official NPI Registry.