NPIMap

Organization Active NPI

Broadlawns Medical Center

  • Pharmacy
  • Des Moines, IA
National Provider Identifier
1013197060
Registry record updated Nov 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
BROADLAWNS MEDICAL CENTER
Practice address
1801 Hickman Road
Des Moines, IA 50314
Phone
(515) 282-2200
Fax
(515) 282-7856
NPI assigned
Nov 7, 2007
Last updated
Nov 11, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
BROADLAWNS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 11, 2013

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

Authorized official

Name
Mr. Jody J Jenner, RN
Title
President Ceo
Phone
(515) 282-2410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU Primary

Addresses

Primary practice location

1801 Hickman Road
Des Moines, IA 50314

Mailing address

1801 Hickman Road
Des Moines, IA 50314
Phone (515) 282-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040206000913 IA Part B Supplier - Clinic/Group Practice 3678466166 Receives reassigned benefits from 547 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Des Moines, IA
O20220202001124 IA Part B Supplier - Pharmacy 3678466166 Practice locations: Des Moines, IA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Anesthesiology Service16 organizations share this tax ID, including this one
Part of
Anesthesiology Service

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

1300 Walnut St
Des Moines, IA 50309
Phone (515) 282-2296

1420 Mulberry St
Des Moines, IA 50309
Phone (515) 284-5719

1914 Carpenter Ave
Des Moines, IA 50314
Phone (515) 282-5742

2508 E University Ave
Des Moines, IA 50317
Phone (515) 282-2362

2970 University Ave
Des Moines, IA 50311
Phone (515) 216-5100

580 SW 9th St
Ste 100
Des Moines, IA 50309
Phone (515) 282-2362

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Broadlawns Medical CenterDes Moines, IA, CCN 160101 Hospital Operational/Managerial Control Nov 16, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 530

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 530

NPI Registry JSON

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384128000000",
    "number": "1013197060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 HICKMAN ROAD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "50314",
            "telephone_number": "515-282-2200",
            "fax_number": "515-282-7856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 HICKMAN ROAD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "50314",
            "telephone_number": "515-282-2200",
            "fax_number": "515-282-7856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADLAWNS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROADLAWNS MEDICAL CENTER",
        "enumeration_date": "2007-11-07",
        "last_updated": "2013-11-11",
        "status": "A",
        "authorized_official_last_name": "JENNER",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "515-282-2410",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.