GREAT RIVER MEDICAL CENTER (NPI# 1265411144) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265411144 |
| Entity Type | Organization |
| Organization Name | GREAT RIVER MEDICAL CENTER |
| Other Organization Name | GREAT RIVER KLEIN CENTER |
| Practice Address |
1307 S Gear Ave West Burlington IA 52655-1604 |
| Mailing Address |
1221 S Gear Ave West Burlington IA 52655-1679 |
| Practice Telephone | 3197684600 |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2019-03-28 |
| Authorized Official Name | MATTHEW WENZEL (CEO/PRESIDENT) |
| Authorized Official Telephone | 3197683260 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | Nursing & Custodial Care Facilities | ||
| Y | 314000000X | Skilled Nursing Facility | 290147H | IA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0651109 | 05 | |
| IA | SKILLED UNIT | 65110 | 01 |
| Other Name | Type Code |
|---|---|
| Great River Klein Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053315002 | Great River Medical Center | Hospice Care, Community Based | 1306 S Washington Rd, West Burlington, IA 52655-1703 | 2005-06-08 |
| 1811068646 | Great River Medical Center | General Acute Care Hospital | 1520 N Division St, Blytheville, AR 72315-1448 | 2006-11-13 |
| 1164433884 | Great River Medical Center | Emergency Medical Technician, Basic | 1221 S Gear Ave, West Burlington, IA 52655-1679 | 2006-08-10 |
| 1134168263 | Great River Medical Center | General Acute Care Hospital | 1221 S Gear Ave, West Burlington, IA 52655-1679 | 2006-06-05 |
| 1760461644 | Great River Medical Center | Home Health | 1306 S Washington Rd, West Burlington, IA 52655-1703 | 2006-01-10 |
| 1639158595 | Great River Medical Center | Rehabilitation Unit | 1221 S Gear Ave, West Burlington, IA 52655-1679 | 2006-01-10 |
| 1598744476 | Great River Medical Center | Home Delivered Meals | 1221 S Gear Ave, West Burlington, IA 52655-1679 | 2006-01-10 |
| 1386623262 | Great River Medical Center | Nursing Facility/Intermediate Care Facility | 1307 S Gear Ave, West Burlington, IA 52655-1604 | 2006-01-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | GREAT RIVER MEDICAL CENTER | 1221 S. Gear Ave, West Burlington, IA 52655 |
| Iowa Business Entities | GREAT RIVER MEDICAL CENTER STAFF FOUNDATION | 200 Jefferson Street, Burlington, IA 52601 |
| Street Address |
1307 S GEAR AVE |
| City | WEST BURLINGTON |
| State | IA |
| Zip Code | 52655-1604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457905705 | Stephanie Monique Hansen | Nurse Practitioner | 1307 S Gear Ave, West Burlington, IA 52655-1604 | 2019-07-25 |
| 1609285279 | Dean Jeffrey Vantiger | Nurse Practitioner | 1307 S Gear Ave, West Burlington, IA 52655-1604 | 2014-08-08 |
| 1386623262 | Great River Medical Center | Nursing Facility/Intermediate Care Facility | 1307 S Gear Ave, West Burlington, IA 52655-1604 | 2006-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679920045 | Breanne Vogel | Nurse Practitioner | 1225 South Gear Avenue, Suite 159, Great River Family Practice Clinic, West Burlington, IA 52655 | 2016-05-16 |
| 1639538010 | Kala Haisch | Nurse Practitioner | 1225 S. Gear Ave., Mercy Plaza, Suite 251, West Burlington, IA 52655 | 2016-02-15 |
| 1326305830 | Ryan Deets | Surgery | 1223 S Gear Ave Ste 202, West Burlington, IA 52655 | 2012-04-20 |
| 1912100173 | Jennifer Yancey | Dietitian, Registered | Great River Medical Center Center for Rehabilitation, 1401 W. Agency Rd., West Burlington, IA 52655 | 2007-06-06 |
| 1043348196 | Wilson Hearing Aids & Services Inc | Hearing Instrument Specialist | 313 E Agency Rd, West Burlington, IA 52655 | 2007-03-01 |
| 1730286204 | Eric A Hanks | Chiropractor | 433 E Mt Pleasant St, West Burlington, IA 52655 | 2006-09-19 |
| 1093825176 | Michael Steven Mathews | Dentist | 409 Layne Dr, West Burlington, IA 52655 | 2006-08-30 |
| 1952383259 | Craig Huston | Emergency Medical Technician, Basic | 1221d S Gear Ave, West Burlington, IA 52655 | 2005-11-14 |
| 1932101466 | Theron Jameson | Specialist | 1225 S Gear Ave, Ste 159, West Burlington, IA 52655 | 2005-08-15 |
| 1255339750 | Community Health Centers of Southeastern Iowa Inc | Internal Medicine | 1706 West Agency Road, West Burlington, IA 52655 | 2005-07-08 |
| Find all providers in zip 52655 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326647165 | Ema Rehabilitation, LLC | Skilled Nursing Facility | 1831 E Kanesville Blvd, Council Bluffs, IA 51503-4767 | 2020-10-22 |
| 1770198855 | Wellspire-bettendorf LLC | Skilled Nursing Facility | 4699 53rd Ave, Bettendorf, IA 52722 | 2020-09-15 |
| 1114547395 | Bvm-phs Senior Housing Inc | Skilled Nursing Facility | 1160 Carmel Dr, Dubuque, IA 52003-7911 | 2020-04-17 |
| 1659920320 | Phs Walnut Ridge LLC | Skilled Nursing Facility | 1703 Campus Drive, Clive, IA 50325 | 2019-09-05 |
| 1992354666 | Phs Council Bluffs, Inc | Skilled Nursing Facility | 16 Valley View Drive, Council Bluffs, IA 51503 | 2019-09-05 |
| 1023679057 | Bcp Union Park, LLC | Skilled Nursing Facility | 2401 E 8th St, Des Moines, IA 50316-1717 | 2019-06-20 |
| 1639637143 | Wellspire LLC | Skilled Nursing Facility | 5508 Nw 88th St, Johnston, IA 50131-3005 | 2019-03-05 |
| 1356807101 | Accura Healthcare of Aurelia LLC | Skilled Nursing Facility | 401 W 5th St, Aurelia, IA 51005-7712 | 2019-02-18 |
| 1093286395 | Ccrc of West Des Moines, LLC | Skilled Nursing Facility | 8950 Coachlight Drive, West Des Moines, IA 50266 | 2018-12-12 |
| 1255828919 | Brio of Johnston, LLC | Skilled Nursing Facility | 6901 Peckham St, Johnston, IA 50131-3143 | 2018-04-18 |
| Find all providers with the same taxonomy | ||||
| City | WEST BURLINGTON |
| Zip Code | 52655 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.