NPIMap

Individual provider Active NPI

John Daniel Engelken, M.D.

  • Diagnostic Radiology Physician
  • Dubuque, IA
National Provider Identifier
1033161096
Registry record updated Dec 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
36070 Issued in IA
Practice address
250 Mercy Dr
Dubuque, IA 52001-7320
Phone
(563) 589-8796
Fax
(563) 589-8776
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 36070 IA 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
0488361MedicaidIA
20549OtherIABCBS PIN
34852900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
East Central Florida Outpatient Imaging, LLC Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging LLC Diagnostic Radiology Past Accepting new patients
Radiology Imaging Associates PA Diagnostic Radiology Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jack.engelken.1@21022.direct.athenahealth.com

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197331200000",
    "number": "1033161096",
    "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"
        },
        {
            "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": {
        "last_name": "ENGELKEN",
        "first_name": "JOHN",
        "middle_name": "DANIEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2007-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "36070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0488361",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "20549",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34852900",
            "state": "WI"
        }
    ],
    "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.