Active NPI
Donald Richard Wirtanen, D.O.
- Family Medicine Physician
- Bloomfield, IA
National Provider Identifier
1184623985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 82100
- Practice address
- 202 N Madison St
Bloomfield, IA 52537-1425 - Phone
- (641) 664-1400
- Fax
- (641) 664-1410
- NPI assigned
- Jul 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 82100 | IA | Primary |
Addresses
Primary practice location
202 N Madison St
Bloomfield, IA 52537-1425
Mailing address
202 N Madison St
Bloomfield, IA 52537-1425
Phone (641) 664-1400
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821295494 | Medicaid | IA | |
| 1184623985 | Other | IA | MEDICARE |
| 242195006 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100524000503 | IA | Practitioner - Family Practice | 7517959448 |
Reassigns benefits to 2 organizations Receives reassigned benefits from 1 practitioner Practice locations: Bloomfield, IA |
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 93.78 of 100
- Quality
- 80.38
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02100 | IA | MD | Optometrist |
| 82100 | IA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Davis County Hospital | Current | Accepting new patients | |
| Davis County Hospital | Current | Accepting new patients | |
| Davis County Hospital | Current | Accepting new patients | |
| John J Finneran MD PC | Family Medicine | Past | Accepting new patients |
| Donald R Wirtanen DO | Family Medicine | Past | Accepting new patients |
Locations
509 N Madison St
Bloomfield, IA 52537
Phone (641) 664-2145
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
Organizations & group practices 5
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.
-
- Rural Health Clinic/Center
- Bloomfield, IA
- NPI 1821413667
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275609600000",
"number": "1184623985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 N MADISON ST",
"city": "BLOOMFIELD",
"state": "IA",
"postal_code": "525371425",
"telephone_number": "641-664-1400",
"fax_number": "641-664-1410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 N MADISON ST",
"city": "BLOOMFIELD",
"state": "IA",
"postal_code": "525371425",
"telephone_number": "641-664-1400",
"fax_number": "641-664-1410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIRTANEN",
"first_name": "DONALD",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-14",
"last_updated": "2010-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "82100",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1821295494",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "1184623985",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "242195006",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.