NPIMap

Organization Active NPI

State University of Iowa

Doing business as Plastic & Reconstructive Surgery Consultants of University of Iowa

  • Plastic and Reconstructive Surgery Physician
  • Cedar Rapids, IA
National Provider Identifier
1114390358
Registry record updated Jan 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
STATE UNIVERSITY OF IOWA
Doing business as
Plastic & Reconstructive Surgery Consultants of University of Iowa
Practice address
3705 River Ridge Dr NE
Cedar Rapids, IA 52402-7596
Phone
(319) 393-1902
NPI assigned
Nov 10, 2015
Last updated
Jan 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2016

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU
Plastic and Reconstructive Surgery Physician 2086S0122X NU Primary

Addresses

Primary practice location

3705 River Ridge Dr NE
Cedar Rapids, IA 52402-7596

Mailing address

3705 River Ridge Dr NE
Cedar Rapids, IA 52402-7596
Phone (319) 393-1902

Other names 1

  • Plastic & Reconstructive Surgery Consultants of University of Iowa 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

NPI Registry JSON

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

{
    "created_epoch": "1447113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451865600000",
    "number": "1114390358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 RIVER RIDGE DR NE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524027596",
            "telephone_number": "319-393-1902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 RIVER RIDGE DR NE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524027596",
            "telephone_number": "319-393-1902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE UNIVERSITY OF IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-10",
        "last_updated": "2016-01-04",
        "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": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plastic & Reconstructive Surgery Consultants of University of Iowa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; 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.