NPIMap

Organization Active NPI

State University of Iowa

Doing business as University of Iowa Children's Hospital Gen Pediatrics-North Liberty

  • Pediatrics Physician
  • North Liberty, IA
National Provider Identifier
1063802791
Registry record updated Feb 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
STATE UNIVERSITY OF IOWA
Doing business as
University of Iowa Children's Hospital Gen Pediatrics-North Liberty
Practice address
1765 Lininger LN
North Liberty, IA 52317-2316
Phone
(319) 467-7888
Fax
(319) 467-7889
NPI assigned
Feb 3, 2015
Last updated
Feb 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2015

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

Authorized official

Name
Philip E Roudabush
Title
Director, Patient Financial Service
Phone
(319) 384-2334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1765 Lininger LN
North Liberty, IA 52317-2316

Mailing address

1765 Lininger LN
North Liberty, IA 52317-2316
Phone (319) 467-7888

Other names 1

  • University of Iowa Children's Hospital Gen Pediatrics-North Liberty Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000060 IA Part B Supplier - Clinic/Group Practice 7618884230 Receives reassigned benefits from 2,348 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 36

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 36

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1063802791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 LININGER LN",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523172316",
            "telephone_number": "319-467-7888",
            "fax_number": "319-467-7889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 LININGER LN",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523172316",
            "telephone_number": "319-467-7888",
            "fax_number": "319-467-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE UNIVERSITY OF IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-03",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "ROUDABUSH",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR, PATIENT FINANCIAL SERVICE",
        "authorized_official_telephone_number": "319-384-2334"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University of Iowa Children's Hospital Gen Pediatrics-North Liberty",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Liberty, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.