NPIMap

Individual provider Active NPI

Brad Michael Willenbring, D.O.

  • Family Medicine Physician
  • Grimes, IA
National Provider Identifier
1124464185
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
05623 Issued in IA
Practice address
825 NE Gateway Dr Ste 148
Grimes, IA 50111-1307
Phone
(515) 875-9607
Fax
(515) 875-9608
NPI assigned
May 17, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 05623 IA Primary

Addresses

Primary practice location

825 NE Gateway Dr Ste 148
Grimes, IA 50111-1307

Mailing address

PO Box 424
Des Moines, IA 50302-0424
Phone (515) 875-9255

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bradwillenbring@tic.allscriptsdirect.net Direct

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
I20200807002411 IA Practitioner - Family Practice 2961758826 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Iowa Clinic PC 307 clinicians

Practice addresses (Care Compare)

825 NE Gateway Dr
Suite 148
Grimes, IA 50111-1307
Phone (515) 875-9607

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
The Iowa Clinic, PC CurrentSince Oct 21, 2024 Accepting new patients
The Iowa Clinic PC Family Medicine CurrentSince Oct 21, 2024 Accepting new patients

Locations

825 NE Gateway Dr
Ste 148
Grimes, IA 50111
Phone (515) 875-9607

1005 Pennsylvania Ave
Ste 102A
Ottumwa, IA 52501
Phone (641) 684-2589

Interoperability endpoints

  • Direct secure messaging: brad.willenbring@grandrivermedicalgroup.eclinicaldirectplus.com
  • Direct secure messaging: bwillenbring763007@direct.unitypoint.org

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1368748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1124464185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 424",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503020424",
            "telephone_number": "515-875-9255",
            "fax_number": "515-875-9223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 NE GATEWAY DR STE 148",
            "city": "GRIMES",
            "state": "IA",
            "postal_code": "501111307",
            "telephone_number": "515-875-9607",
            "fax_number": "515-875-9608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLENBRING",
        "first_name": "BRAD",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-17",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "05623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bradwillenbring@tic.allscriptsdirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "825 NE Gateway Dr Ste 148",
            "city": "Grimes",
            "state": "IA",
            "country_code": "US",
            "postal_code": "501111307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grimes, IA

Sources for this page

Verify at the official NPI Registry.