NPIMap

Organization Active NPI

Medical Anesthesia Associates PC

  • Specialist
  • Council Bluffs, IA
National Provider Identifier
1063529014
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MEDICAL ANESTHESIA ASSOCIATES PC
Practice address
201 Ridge St
Suite 102
Council Bluffs, IA 51503-4643
Phone
(712) 322-5565
Fax
(712) 322-5566
NPI assigned
Aug 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

Name
Shelly Marie Schutte, PA-C
Title
Physician Assistant
Phone
(402) 212-9418

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

201 Ridge St
Suite 102
Council Bluffs, IA 51503-4643

Mailing address

201 Ridge St Ste 102
Council Bluffs, IA 51503-4643
Phone (712) 396-4359

Other identifiers 1

IdentifierTypeStateIssuer
0067520MedicaidIA

National Provider Directory

National Provider Directory

Locations

300 W Broadway
Ste 31
Council Bluffs, IA 51503
Phone (712) 322-5565

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12169/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1063529014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 RIDGE ST STE 102",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034643",
            "telephone_number": "712-396-4359",
            "fax_number": "712-396-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 RIDGE ST",
            "address_2": "SUITE 102",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034643",
            "telephone_number": "712-322-5565",
            "fax_number": "712-322-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ANESTHESIA ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "SCHUTTE",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "402-212-9418",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0067520",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.