NPIMap

Organization Active NPI

Covenant Medical Center Inc

Doing business as MercyOne Waterloo Home Medical Equipment

  • Durable Medical Equipment & Medical Supplies
  • Waterloo, IA
National Provider Identifier
1134411416
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
COVENANT MEDICAL CENTER INC
Doing business as
MercyOne Waterloo Home Medical Equipment
Practice address
441 E San Marnan Dr
Waterloo, IA 50702-5900
Phone
(319) 272-7600
Fax
(319) 272-7597
NPI assigned
May 5, 2011
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
Timothy Huber
Title
Cfo
Phone
(319) 272-7607

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X NU
Oxygen Equipment & Supplies (DME) 332BX2000X NU
Prosthetic/Orthotic Supplier 335E00000X NU

Addresses

Primary practice location

441 E San Marnan Dr
Waterloo, IA 50702-5900

Mailing address

PO Box 6280
Waterloo, IA 50704-6280
Phone (319) 272-7600

Other identifiers 2

IdentifierTypeStateIssuer
6217OtherIAWHOLE DRUG LICENSE
1-07-039593 2OtherIAHOUSEHOLD HAXARDOUS MATERIAL RETAILER

Other names 1

  • MercyOne Waterloo Home Medical Equipment Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110624000408 IA DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Medical Supply CompanyDME Supplier - Oxygen & Equipment 0244148732 Practice locations: Waterloo, IA

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mercyone Waterloo Home Medical Equi441 E San Marnan Dr, Waterloo, IA 50702-5900(319) 272-5626 Commodes, Urinals, Bedpans|Heat & Cold Applications|Hospital Beds (Electric)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Ultraviolet Light Devices and/or Supplies|Canes and/or Crutches|Patient Lifts|Seat Lift Mechanisms|Walkers|Wheelchairs (Standard Manual)|Wheelchairs (Standard Manual Relat… Accepts assignmentParticipating since Jul 17, 1990

National Provider Directory

National Provider Directory
Tax ID family
Lee O Fagre MD15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

441 E San Marnan Dr
Waterloo, IA 50702
Phone (319) 234-2644

NPI Registry JSON

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

{
    "created_epoch": "1304553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1134411416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6280",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507046280",
            "telephone_number": "319-272-7600",
            "fax_number": "319-272-7597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 E SAN MARNAN DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025900",
            "telephone_number": "319-272-7600",
            "fax_number": "319-272-7597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-05",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "HUBER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "319-272-7607"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WHOLE DRUG LICENSE",
            "identifier": "6217",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOUSEHOLD HAXARDOUS MATERIAL RETAILER",
            "identifier": "1-07-039593 2",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MercyOne Waterloo Home Medical Equipment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; 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.