COUNTRYSIDE MEDICAL CLINIC, LLC
NPI 1396103685
Clinic/Center - Primary Care in Indianola, IA
About Countryside Medical Clinic, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
COUNTRYSIDE MEDICAL CLINIC, LLC (NPI 1396103685) is a healthcare organization registered as a primary care in Indianola, Iowa and active in the NPI registry since February 2016. The organization lists Kimberly Lynn Rines, Owner/np, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Countryside Medical Clinic, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Countryside Medical Clinic, LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Countryside Medical Clinic, LLC's NPI number?
The NPI number for Countryside Medical Clinic, LLC is 1396103685. It was assigned to this organization in the NPPES registry on February 2, 2016.
Where is Countryside Medical Clinic, LLC located?
Countryside Medical Clinic, LLC is located at 909 E 2nd Ave Ste G, Indianola, IA 50125. The listed phone number is (712) 370-3910.
What is Countryside Medical Clinic, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Countryside Medical Clinic, LLC enrolled in Medicare?
Yes. Countryside Medical Clinic, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Countryside Medical Clinic, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Countryside Medical Clinic, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Countryside Medical Clinic, LLC was last updated on August 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 59 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Countryside Medical Clinic, Llc · NPI 1396103685
Primary Care organization in Indianola, Iowa. Organization record, active in the CMS NPPES registry since February 2, 2016.
## Identity
- **NPI:** 1396103685 (Entity type: Organization)
- **Enumerated:** February 2, 2016
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Kimberly Rines, OWNER/NP
## Practice location
- **Address:** 909 E 2ND AVE STE G, Indianola, IA 50125-2892
- **Phone:** (712) 370-3910 · **Fax:** (888) 573-6009
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 22, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1396103685) · Data from the CMS NPPES public registry.