NPIMap

Individual provider Active NPI

Carolyn Su-Ying Pease, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Des Moines, IA
National Provider Identifier
1073705760
Registry record updated Jun 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
37606 Issued in IA
Practice address
1111 6TH Avenue
Mercy Medical Center
Des Moines, IA 50314
Phone
(515) 643-8533
Fax
(515) 643-8911
NPI assigned
Aug 16, 2007
Last updated
Jun 23, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 49470 MN
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 37606 IA Primary

Addresses

Primary practice location

1111 6TH Avenue
Mercy Medical Center
Des Moines, IA 50314

Mailing address

1111 6TH Avenue
Mercy Medical Center
Des Moines, IA 50314
Phone (515) 643-8533

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
I20081008000605 IA Practitioner - Pathology 9133297864 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathology Associates of Central Iowa PLCGroup PAC ID 6305887811, 8 clinicians

Practice addresses (Care Compare)

1111 6TH Ave
Des Moines, IA 50314-2610

1111 6TH Ave
Des Moines, IA 50314-2611

1111 6TH Ave
Des Moines, IA 50314-2613
Phone (515) 247-4467

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37606IAMDAnatomic Pathology & Clinical Pathology Physician
49470MNMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Associates of Central Iowa, PLC Anatomic Pathology & Clinical Pathology CurrentSince Dec 16, 2009 Accepting new patients

Locations

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

Organizations & group practices 1

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 9

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": "1187222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308787200000",
    "number": "1073705760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 6TH AVENUE",
            "address_2": "MERCY MEDICAL CENTER",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "50314",
            "telephone_number": "515-643-8533",
            "fax_number": "515-643-8911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 6TH AVENUE",
            "address_2": "MERCY MEDICAL CENTER",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "50314",
            "telephone_number": "515-643-8533",
            "fax_number": "515-643-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEASE",
        "first_name": "CAROLYN",
        "middle_name": "SU-YING",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-16",
        "last_updated": "2011-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MN",
            "license": "49470",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IA",
            "license": "37606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.