Individual provider Active NPI

David B Paul, PSYD

  • Clinical Neuropsychologist
  • Clive, IA
National Provider Identifier
1003122805
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
094308 Issued in IA
Practice address
12493 University Ave Ste 100
Clive, IA 50325-8286
Phone
(515) 358-0060
NPI assigned
Aug 31, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 094308 IA Primary
Mental Health Counselor 101YM0800X LASAC-13200 AZ

Addresses

Primary practice location

12493 University Ave Ste 100
Clive, IA 50325-8286

Mailing address

PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 358-0060

Other identifiers 1

IdentifierTypeStateIssuer
117079MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190729003398 IA Practitioner - Clinical Psychologist 5597091579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinics IncGroup PAC ID 7911810882, 441 clinicians

Practice addresses (Care Compare)

12493 University Ave
Clive, IA 50325-8286

330 Laurel St
Suite 1200
Des Moines, IA 50314-3044
Phone (515) 643-6290

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LASAC-13200AZMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinics, Inc. CurrentSince Aug 1, 2019 Accepting new patients
Mercy Clinics, Inc. Current Accepting new patients
Mercy Clinics, Inc CurrentSince Aug 1, 2019 Accepting new patients

Locations

1111 6th Ave
Ste A100
Des Moines, IA 50314
Phone (515) 358-0011

12493 University Ave
Ste 100
Des Moines, IA 50325
Phone (515) 358-0060

1111 6th Ave
Ste B1
Des Moines, IA 50314
Phone (515) 358-0100

405 SW 5th St
Ste E
Des Moines, IA 50309
Phone (515) 358-7259

330 Laurel St
Ste 1200
Des Moines, IA 50314
Phone (515) 643-5454

300 W Hutchings St
Winterset, IA 50273
Phone (515) 223-4368

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DDGADD
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1003122805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-358-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12493 UNIVERSITY AVE STE 100",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258286",
            "telephone_number": "515-358-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAUL",
        "first_name": "DAVID",
        "middle_name": "B",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-31",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IA",
            "license": "094308",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LASAC-13200",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117079",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

Verify at the official NPI Registry.