Southridge Specialty Care – Skilled Nursing Facility, NPI 1700858719
Skilled Nursing Facility
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Southridge Specialty Care
Care Initiatives, 1611, West Lakes Parkway, West Lakes Office Park, Clive, Polk County, Iowa, 50266, United States
WEST DES MOINES, IA 502668212
Phone: (515) 224-4442
Fax: (515) 224-0960
Type: Mailing
Southridge Specialty Care, 309, West Merle Hibbs Boulevard, Marshalltown, Marshall Township, Marshall County, Iowa, 50158, United States
MARSHALLTOWN, IA 501584694
Phone: (641) 752-4553
Fax: (641) 752-7776
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2009-10-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20091002000613 | O | Skilled Nursing Facility | IA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 50266)
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