NPIMap

Organization Active NPI

Des Moines University Osteopathic Medical Center

Doing business as Des Moines University Clinic

  • Family Medicine Physician
  • Des Moines, IA
National Provider Identifier
1164475760
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DES MOINES UNIVERSITY OSTEOPATHIC MEDICAL CENTER
Doing business as
Des Moines University Clinic
Practice address
3200 Grand Ave
Des Moines, IA 50312-4104
Phone
(515) 471-9243
Fax
(515) 471-9319
NPI assigned
May 18, 2006
Last updated
Aug 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Authorized official

Name
Philip C. Blumberg
Title
Administrator
Phone
(515) 271-1574

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X IA
Physician Assistant 363A00000X NU
Clinical Psychologist 103TC0700X NU
Neuromusculoskeletal Medicine & OMM Physician 204D00000X IA
Family Medicine Physician 207Q00000X IA Primary
Internal Medicine Physician 207R00000X IA
Physical Medicine & Rehabilitation Physician 208100000X IA
Psychiatry Physician 2084P0800X NU
Diagnostic Radiology Physician 2085R0202X IA
General Practice Physician 208D00000X IA
Primary Podiatric Medicine Podiatrist 213EP1101X IA
Foot & Ankle Surgery Podiatrist 213ES0103X IA
Physical Therapist 225100000X IA
Occupational Therapist 225X00000X IA

Addresses

Primary practice location

3200 Grand Ave
Des Moines, IA 50312-4104

Mailing address

3200 Grand Ave
Des Moines, IA 50312-4104
Phone (515) 471-9243

Other identifiers 3

IdentifierTypeStateIssuer
0255166MedicaidIA
0255182MedicaidIA
CQ2071OtherIARR MEDICARE

Other names 1

  • Des Moines University Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040226000810 IA Part B Supplier - Clinic/Group Practice 6002713443 Receives reassigned benefits from 42 practitioners
Practice locations: Ames, IA; West Des Moines, IA; Guthrie Center, IA; Des Moines, IA
O20100930013496 IA DME Supplier - Physician - PodiatryDME Supplier - Independently-Practicing Physical TherapistDME Supplier - Physician - Unknown Physician Specialty 6002713443 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Des Moines, IA

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

3200 Grand Ave
Des Moines, IA 50312
Phone (515) 271-1700

6500 Grand Ave
Ste 110
West Des Moines, IA 50266
Phone (515) 271-1725

8025 Grand Ave
West Des Moines, IA 50266
Phone (515) 271-1400

Practitioners & affiliated clinicians

Practitioners 79

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.

View all 79

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1164475760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 GRAND AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503124104",
            "telephone_number": "515-471-9243",
            "fax_number": "515-471-9319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 GRAND AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503124104",
            "telephone_number": "515-471-9243",
            "fax_number": "515-471-9319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DES MOINES UNIVERSITY OSTEOPATHIC MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "BLUMBERG",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "515-271-1574"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0255166",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0255182",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CQ2071",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Des Moines University Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Des Moines University Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; 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.