NPIMap

Organization Active NPI

Mercy Clinics, Inc.

Doing business as MercyOne East Village Family Medicine Clinic

  • Primary Care Clinic/Center
  • Des Moines, IA
National Provider Identifier
1194745752
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MERCY CLINICS, INC.
Doing business as
MercyOne East Village Family Medicine Clinic
MercyOne East Village Internal Medicine
Practice address
1350 Des Moines St Ste 110
Des Moines, IA 50309-5507
Phone
(515) 643-0833
Fax
(515) 643-0933
NPI assigned
Jul 19, 2006
Last updated
Oct 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY CLINICS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Authorized official

Name
Bradley Whipple
Title
Coo
Phone
(515) 358-6956

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X
Internal Medicine Physician 207R00000X
Pediatric Adolescent Medicine Physician 2080A0000X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1350 Des Moines St Ste 110
Des Moines, IA 50309-5507

Mailing address

PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 643-0833

Other practice location 1

1350 Des Moines St Ste 110
Des Moines, IA 50309-5507
Phone (515) 358-6500

Other practice location 2

1350 Des Moines St Ste 100
Des Moines, IA 50309-5507
Phone (515) 643-5700

Other identifiers 2

IdentifierTypeStateIssuer
0450163MedicaidIA
CD3776OtherIARAILROAD MEDICARE

Other names 2

  • MercyOne East Village Family Medicine Clinic Doing business as
  • MercyOne East Village Internal Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000238 IA Part B Supplier - Clinic/Group Practice 7911810882 Receives reassigned benefits from 558 practitioners
This NPI is an additional NPI on the enrollment

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
16D0676807Mercyone East Village Clinics1350 Des Moines Street Ste 100-110, Des Moines, IA 50309Certificate of waiverFeb 28, 2027

National Provider Directory

National Provider Directory
Part of
Mercy West Radiology Center

Locations

1350 Des Moines St
Ste 100
Des Moines, IA 50309
Phone (515) 643-0400

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728604800000",
    "number": "1194745752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-643-0833",
            "fax_number": "515-643-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 DES MOINES ST STE 110",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503095507",
            "telephone_number": "515-643-0833",
            "fax_number": "515-643-0933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 Des Moines St Ste 110",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503095507",
            "country_code": "US",
            "telephone_number": "515-358-6500",
            "fax_number": "515-643-8812",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1350 Des Moines St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503095507",
            "country_code": "US",
            "telephone_number": "515-643-5700",
            "fax_number": "515-643-5739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MERCY CLINICS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY CLINICS, INC.",
        "enumeration_date": "2006-07-19",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A",
        "authorized_official_last_name": "WHIPPLE",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "515-358-6956"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0450163",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD3776",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MercyOne East Village Family Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MercyOne East Village Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MercyOne East Village Internal Medicine",
            "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 Oct 11, 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.