Quad Cities Internal Medicine PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

27082 Issued in IA

Legal business name

QUAD CITIES INTERNAL MEDICINE PC

Practice address

3509 Spring St
Suite 3
Davenport, IA 52807-2124

Phone

(563) 359-5011

Fax

(359) 355-3438

NPI assigned

Mar 30, 2007

Last updated

Jan 16, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Debra M Jaegle, M.D.

Title

Owner

Phone

(563) 359-5011

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358294400000",
    "number": "1053431437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3509 SPRING ST",
            "address_2": "SUITE 3",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072124",
            "telephone_number": "563-359-5011",
            "fax_number": "359-355-3438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 SPRING ST",
            "address_2": "SUITE 3",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072124",
            "telephone_number": "563-359-5011",
            "fax_number": "359-355-3438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUAD CITIES INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2013-01-16",
        "status": "A",
        "authorized_official_last_name": "JAEGLE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-359-5011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "27082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "20088",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0487322",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1057778",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Davenport, IA
• Providers in Davenport, IA by specialty
• Internal Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; 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.