NPIMap

Organization Active NPI

North Iowa Mercy Clinics

Doing business as MercyOne Clear Lake Pediatric & Adolescent Clinic

  • Pediatric Adolescent Medicine Physician
  • Clear Lake, IA
National Provider Identifier
1093720708
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
NORTH IOWA MERCY CLINICS
Doing business as
MercyOne Clear Lake Pediatric & Adolescent Clinic
Practice address
401 S 15TH St
Clear Lake, IA 50428-2303
Phone
(641) 357-7442
Fax
(641) 357-6020
NPI assigned
Jul 30, 2006
Last updated
Mar 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

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

Authorized official

Name
Mark C Trammel
Title
VP Finanace
Phone
(641) 428-7984

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X NU Primary

Addresses

Primary practice location

401 S 15TH St
Clear Lake, IA 50428-2303

Mailing address

1000 4TH St SW
Mason City, IA 50401-2800
Phone (641) 357-7442

Other names 1

  • MercyOne Clear Lake Pediatric & Adolescent Clinic Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions
Direct Messaging Address tate.lage.p43@direct.trinity-healthiowa.nextgenshare.com Direct MercyOne North Iowa

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000273 IA Part B Supplier - Clinic/Group Practice 7810809076 Receives reassigned benefits from 477 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 39

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

View all 39

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0982409Mercyone Clear Lake401 South 15TH Street, Clear Lake, IA 50428Certificate of waiverJan 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cobius Healthcare Solutions23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

401 S 15th St
Clear Lake, IA 50428
Phone (641) 357-3393

Interoperability endpoints

  • Direct secure messaging: tate.lage.p43@direct.trinity-healthiowa.nextgenshare.com

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": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772668800000",
    "number": "1093720708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 4TH ST SW",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504012800",
            "telephone_number": "641-357-7442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S 15TH ST",
            "city": "CLEAR LAKE",
            "state": "IA",
            "postal_code": "504282303",
            "telephone_number": "641-357-7442",
            "fax_number": "641-357-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH IOWA MERCY CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A",
        "authorized_official_last_name": "TRAMMEL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP FINANACE",
        "authorized_official_telephone_number": "641-428-7984"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tate.lage.p43@direct.trinity-healthiowa.nextgenshare.com",
            "affiliation": "Y",
            "endpointDescription": "Direct Email Address",
            "affiliationName": "MercyOne North Iowa",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "401 S 15th St",
            "city": "Clear Lake",
            "state": "IA",
            "country_code": "US",
            "postal_code": "504282303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MercyOne Clear Lake Pediatric & Adolescent Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clear Lake, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.