NPIMap

Mercy Physician Associates, Inc

Organization Active NPI Rural Health Clinic/Center · Tama, IA

NPI 1154490779 · NPPES record last updated Jun 15, 2026

Key facts

NPI
1154490779
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
MERCY PHYSICIAN ASSOCIATES, INC
Practice address
402 Siegel St
Tama, IA 52339-2302
Phone
(641) 484-3333
Fax
(319) 369-4677
NPI assigned
Nov 7, 2006
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 29

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

View all 29

Other NPIs with the same Medicare PAC ID 2

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

Practitioners 104

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

View all 104

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D1015260Mercycare Tama
402 Siegel Street, Tama, IA 52339		ComplianceJan 7, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IA

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
Corporation · Proprietary
Enrollment address
402 Siegel St
Tama, IA 52339-2302

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 Officer
Interim President & C.E.O		 Apr 4, 2026
Operational/Managerial Control
Interim President & C.E.O		 Apr 4, 2026
Joseph Malas
Individual 		Corporate Officer
Executive Vice President & C.F.O.		 Mar 30, 2026
W-2 Managing Employee Mar 30, 2026

Medicare enrollment records

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

National Provider Directory

Specialties & licenses

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

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

  • MercyCare Tama Doing business as

Other providers in Tama, IA

All providers in Tama, IA · Rural Health Clinic/Center in Iowa

Sources for this page

Verify at the official NPI Registry.