NPIMap

Organization Active NPI

C.a. Hendricks M.D. P.C.

  • Point of Service
  • Cedar Rapids, IA
National Provider Identifier
1043468564
Registry record updated Sep 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
15724 Issued in IA
Legal business name
C.A. HENDRICKS M.D. P.C.
Practice address
1136 H Ave NE
Cedar Rapids, IA 52402-4624
Phone
(319) 362-9855
Fax
(319) 362-0655
NPI assigned
Sep 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2008

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

Authorized official

Name
Dr. Clifford Hendricks, M.D.
Title
Doctor
Phone
(319) 362-9855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X 15724 IA Primary

Addresses

Primary practice location

1136 H Ave NE
Cedar Rapids, IA 52402-4624

Mailing address

1136 H Ave NE
Cedar Rapids, IA 52402-4624
Phone (319) 362-9855

Other identifiers 4

IdentifierTypeStateIssuer
0029744MedicaidIA
181765472OtherRR MEDICARE
02974OtherIABCBS
4501OtherIAMIDLANDS

National Provider Directory

National Provider Directory

Locations

1136 H Ave NE
Cedar Rapids, IA 52402
Phone (319) 362-9855

NPI Registry JSON

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220918400000",
    "number": "1043468564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 H AVE NE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524024624",
            "telephone_number": "319-362-9855",
            "fax_number": "319-362-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 H AVE NE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524024624",
            "telephone_number": "319-362-9855",
            "fax_number": "319-362-0655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C.A. HENDRICKS M.D. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-09",
        "last_updated": "2008-09-09",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "319-362-9855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "IA",
            "license": "15724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0029744",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "181765472",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02974",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS",
            "identifier": "4501",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; 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.