NPIMap

Individual provider Active NPI

Kevin Pothoven, M.D.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Des Moines, IA
National Provider Identifier
1053368498
Registry record updated Jun 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
4301078608 Issued in MI
Practice address
1111 6TH Ave
Des Moines, IA 50314-2613
Phone
(515) 247-3211
Fax
(515) 643-8722
NPI assigned
May 30, 2006
Last updated
Jun 9, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 4301078608 MI Primary

Addresses

Primary practice location

1111 6TH Ave
Des Moines, IA 50314-2613

Mailing address

PO Box 4925
Des Moines, IA 50305-4925
Phone (515) 643-4374

Other identifiers 4

IdentifierTypeStateIssuer
06127OtherIABC/BS OF IOWA
104703457MedicaidMI
KP078608OtherMIBC/BS OF MICHIGAN
104631572MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070717000014 IA Practitioner - Emergency Medicine 7012985302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Des Moines River Physicians LLCGroup PAC ID 0143549634, 45 clinicians

Practice addresses (Care Compare)

1111 6TH Ave
Des Moines, IA 50314-2613
Phone (515) 247-3121

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.29 of 100Reported as group
Quality
80.31
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301078608MIMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Des Moines River Physicians, LLC CurrentSince May 1, 2015 Accepting new patients
Des Moines River Physicians, LLC CurrentSince May 1, 2015 Accepting new patients
Des Moines River Physicians, LLC Current Accepting new patients

Locations

1111 6th Ave
Des Moines, IA 50314
Phone (515) 247-3121

204 N 4th Ave E
Newton, IA 50208
Phone (641) 791-4800

1755 59th Pl
West Des Moines, IA 50266
Phone (515) 247-4240

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • Direct secure messaging: kpothoven3955128@direct.trinity-health.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244505600000",
    "number": "1053368498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4925",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503054925",
            "telephone_number": "515-643-4374",
            "fax_number": "515-643-2784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142613",
            "telephone_number": "515-247-3211",
            "fax_number": "515-643-8722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTHOVEN",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2009-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "4301078608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF IOWA",
            "identifier": "06127",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104703457",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MICHIGAN",
            "identifier": "KP078608",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104631572",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.