NPIMap

Organization Active NPI

Diagnostic & Int Med Assoc PC

  • Internal Medicine Physician
  • Council Bluffs, IA
National Provider Identifier
1104870690
Registry record updated Nov 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DIAGNOSTIC & INT MED ASSOC PC
Practice address
201 Ridge St
Suite 302
Council Bluffs, IA 51503-4643
Phone
(712) 322-5532
Fax
(800) 293-4214
NPI assigned
May 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2013

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

Authorized official

Name
Barry L Kricsfeld, MD FACP
Title
President Owner
Phone
(712) 322-5532

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

201 Ridge St
Suite 302
Council Bluffs, IA 51503-4643

Mailing address

201 Ridge St
Suite 302
Council Bluffs, IA 51503-4643
Phone (712) 322-5532

Other identifiers 2

IdentifierTypeStateIssuer
0129437MedicaidIA
CP8208OtherIARAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

201 Ridge St
Ste 302
Council Bluffs, IA 51503
Phone (712) 322-5532

801 Harmony St
Ste 402
Council Bluffs, IA 51503
Phone (402) 933-7247

8303 Dodge St
#H
Omaha, NE 68114
Phone (402) 354-4000

Practitioners & affiliated clinicians

Practitioners 141

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

View all 141

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384387200000",
    "number": "1104870690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 RIDGE ST",
            "address_2": "SUITE 302",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034643",
            "telephone_number": "712-322-5532",
            "fax_number": "800-293-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 RIDGE ST",
            "address_2": "SUITE 302",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034643",
            "telephone_number": "712-322-5532",
            "fax_number": "800-293-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC & INT MED ASSOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2013-11-14",
        "status": "A",
        "authorized_official_last_name": "KRICSFELD",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "712-322-5532",
        "authorized_official_credential": "MD FACP"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0129437",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CP8208",
            "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 Nov 14, 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.