NPIMap

Organization Active NPI

Mercy Radiologists of Dubuque, P.C.

  • Diagnostic Radiology Physician
  • Dubuque, IA
National Provider Identifier
1013968205
Registry record updated Dec 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MERCY RADIOLOGISTS OF DUBUQUE, P.C.
Practice address
250 Mercy Dr
Dubuque, IA 52001-7320
Phone
(563) 589-8796
Fax
(563) 589-8776
NPI assigned
May 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2007

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

Authorized official

Name
Stephen Michael Clifford, M.D.
Title
President
Phone
(563) 589-8796

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

250 Mercy Dr
Dubuque, IA 52001-7320

Mailing address

250 Mercy Dr
Dubuque, IA 52001-7320
Phone (563) 589-8796

Other identifiers 3

IdentifierTypeStateIssuer
32694100MedicaidWI
0129627MedicaidIA
12962OtherIAWELLMARK BLUE CROSS BLUE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317000659 IA Part B Supplier - Clinic/Group Practice 9436049152 Receives reassigned benefits from 8 practitioners
Practice locations: Elkader, IA; Dyersville, IA; Dubuque, IA

National Provider Directory

National Provider Directory

Locations

200 Mercy Dr
Ste 104
Dubuque, IA 52001

1111 3rd St SW
Dyersville, IA 52040
Phone (563) 875-2953

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1013968205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 MERCY DR",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520017320",
            "telephone_number": "563-589-8796",
            "fax_number": "563-589-8776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 MERCY DR",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520017320",
            "telephone_number": "563-589-8796",
            "fax_number": "563-589-8776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY RADIOLOGISTS OF DUBUQUE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-13",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "CLIFFORD",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "563-589-8796",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32694100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0129627",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CROSS BLUE",
            "identifier": "12962",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dubuque, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.