Active NPI
Tara Gravenstine, DO
- Family Medicine Physician
- Newton, IA
National Provider Identifier
1043698939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO-05909
- Practice address
- 300 N 4TH Ave E Ste 200
Newton, IA 50208-3179 - Phone
- (641) 792-2112
- Fax
- (641) 792-8484
- NPI assigned
- May 11, 2015
- Last updated
- Dec 2, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 52087 | SC | |
| Family Medicine Physician | 207Q00000X | DO-05909 | IA | Primary |
Addresses
Primary practice location
300 N 4TH Ave E Ste 200
Newton, IA 50208-3179
Mailing address
PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DO-05909 | Other | IA | FAMILY PRACTICE |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
300 N 4TH Ave E
Suite 200
Newton, IA 50208-3122
Phone (641) 792-2112
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 14 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newton Clinic PC | Family Medicine | Current | Accepting new patients |
| Mercy Medical Center-Newton | Past | Accepting new patients |
Locations
300 N 4th Ave E
Ste 200
Newton, IA 50208
Phone (641) 792-2112
Interoperability endpoints
- dgravenstine296316@ecommunitydirect.com
- https://api.platform.athenahealth.com/31005/brand/1/csg/1/fhir/r4
- tara.gravenstine.1@31005.direct.athenahealth.com
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.
-
- Family Medicine Physician
- Newton, IA
- NPI 1730115213
-
dba MercyOne Newton Medical Center
- General Acute Care Hospital
- Newton, IA
- NPI 1003296179
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba MercyOne West Des Moines Medical Center
- General Acute Care Hospital
- West Des Moines, IA
- NPI 1538395975
-
dba MercyOne Des Moines Laboratory
- Clinical Medical Laboratory
- Des Moines, IA
- NPI 1104982743
Hospital
-
dba MercyOne Des Moines Medical Center
- General Acute Care Hospital
- Des Moines, IA
- NPI 1508964883
-
dba Mercy Medical Mammography Center
- Mammography Clinic/Center
- Des Moines, IA
- NPI 1477984367
Hospital
-
dba MercyOne Newton Medical Center
- General Acute Care Hospital
- Newton, IA
- NPI 1003296179
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638403200000",
"number": "1043698939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 743070",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303743070",
"telephone_number": "864-560-4304",
"fax_number": "864-560-4413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N 4TH AVE E STE 200",
"city": "NEWTON",
"state": "IA",
"postal_code": "502083179",
"telephone_number": "641-792-2112",
"fax_number": "641-792-8484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVENSTINE",
"first_name": "TARA",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-11",
"last_updated": "2021-12-02",
"certification_date": "2021-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "52087",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "DO-05909",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FAMILY PRACTICE",
"identifier": "DO-05909",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newton, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.