NPIMap

Organization Active NPI

Mercy Physician Associates, Inc

Doing business as MercyCare Tama

  • Rural Health Clinic/Center
  • Tama, IA
National Provider Identifier
1154490779
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY PHYSICIAN ASSOCIATES, INC
Doing business as
MercyCare Tama
Practice address
402 Siegel St
Tama, IA 52339-2302
Phone
(641) 484-3333
Fax
(319) 369-4677
NPI assigned
Nov 7, 2006
Last updated
Jun 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

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

Authorized official

Name
Gregory Dewolf
Title
Interim President & Ceo
Phone
(319) 398-6101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

402 Siegel St
Tama, IA 52339-2302

Mailing address

PO Box 1824
Cedar Rapids, IA 52406
Phone (319) 369-4505

Other names 1

  • MercyCare Tama Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040120000805 IA Part B Supplier - Clinic/Group Practice 1355242496 Receives reassigned benefits from 135 practitioners
36 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Central City, IA; Cedard Rapids, IA; Hiawatha, IA; Manchester, IA; Marengo, IA; Marion, IA; Monticello, IA; Mt Vernon, IA…
O20040427000316 IA Part A Provider - Rural Health Clinic 1355242496 Practice locations: Tama, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154490779. Details of each certification follow.

Rural health clinic certification: CCN 168949

Legal name
MERCY PHYSICIAN ASSOCIATES INC
Doing business as
MERCYCARE TAMA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 18, 2005
Last certification
Dec 7, 2022
Ownership / control type
1B
Organization structure
CorporationProprietary
Enrollment address
402 Siegel St
Tama, IA 52339-2302

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 29

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

View all 29

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
16D1015260Mercycare Tama402 Siegel Street, Tama, IA 52339ComplianceJan 7, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gregory B Dewolf Individual Corporate OfficerInterim President & C.E.O Apr 4, 2026
Operational/Managerial ControlInterim President & C.E.O Apr 4, 2026
Joseph Malas Individual Corporate OfficerExecutive Vice President & C.F.O. Mar 30, 2026
W-2 Managing Employee Mar 30, 2026

Practitioners & affiliated clinicians

Practitioners 3

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": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1154490779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1824",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "52406",
            "telephone_number": "319-369-4505",
            "fax_number": "319-369-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 SIEGEL ST",
            "city": "TAMA",
            "state": "IA",
            "postal_code": "523392302",
            "telephone_number": "641-484-3333",
            "fax_number": "319-369-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY PHYSICIAN ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "DEWOLF",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "INTERIM PRESIDENT & CEO",
        "authorized_official_telephone_number": "319-398-6101"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MercyCare Tama",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tama, IA

Sources for this page

Verify at the official NPI Registry.