Individual provider Active NPI

Mauricio Amoedo

  • Vascular & Interventional Radiology Physician
  • Iowa City, IA
National Provider Identifier
1003658766
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
SP-0279 Issued in IA
Practice address
200 Hawkins Dr
Iowa City, IA 52242-1009
Phone
(319) 353-6992
Fax
(319) 353-8780
NPI assigned
Jun 12, 2024
Last updated
Dec 16, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X SP-0279 IA
Diagnostic Radiology Physician 2085R0202X SP-0279 IA
Vascular & Interventional Radiology Physician 2085R0204X SP-0279 IA Primary

Addresses

Primary practice location

200 Hawkins Dr
Iowa City, IA 52242-1009

Mailing address

200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 353-6992

Other practice location 1

701 W Forevergreen Rd
North Liberty, IA 52317-9848
Phone (319) 356-3375

Other practice location 2

500 E Market St
Iowa City, IA 52245-2633
Phone (319) 339-3551

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240719000120 IA Practitioner - Diagnostic Radiology 8022554633 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State University of IowaGroup PAC ID 7618884230, 1,886 clinicians

Practice addresses (Care Compare)

200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 356-1616

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
SP-0279IAMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State University of Iowa CurrentSince Jun 5, 2024 Accepting new patients
State University of Iowa Past Accepting new patients

Locations

200 Hawkins Dr
Iowa City, IA 52242
Phone (319) 356-2633

200 Hawkins Dr
#H
Iowa City, IA 52242

500 E Market St
Iowa City, IA 52245
Phone (319) 339-0300

701 W Forevergreen Rd
North Liberty, IA 52317
Phone (319) 356-2223

Organizations & group practices 2

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1003658766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-353-6992",
            "fax_number": "319-353-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-353-6992",
            "fax_number": "319-353-8780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 W Forevergreen Rd",
            "address_purpose": "LOCATION",
            "city": "North Liberty",
            "state": "IA",
            "postal_code": "523179848",
            "country_code": "US",
            "telephone_number": "319-356-3375",
            "fax_number": "319-356-3949",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 E Market St",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522452633",
            "country_code": "US",
            "telephone_number": "319-339-3551",
            "fax_number": "319-248-7945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMOEDO",
        "first_name": "MAURICIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-12",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "IA",
            "license": "SP-0279",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "SP-0279",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IA",
            "license": "SP-0279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iowa City, IA

Sources for this page

Verify at the official NPI Registry.