NPIMap

Organization Active NPI

Des Moines Pediatric & Adolescent Clinic

  • Pediatrics Physician
  • Des Moines, IA
National Provider Identifier
1194991109
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
DES MOINES PEDIATRIC & ADOLESCENT CLINIC
Practice address
2301 Beaver Ave
Des Moines, IA 50310-3903
Phone
(515) 255-3181
Fax
(515) 255-9392
NPI assigned
Apr 30, 2008
Last updated
Dec 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Rob Fornoff, M.D.
Title
Owner
Phone
(515) 255-3181

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

2301 Beaver Ave
Des Moines, IA 50310-3903

Mailing address

2301 Beaver Ave
Des Moines, IA 50310-3903
Phone (515) 255-3181

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
16D0383437Des Moines Pediatric & Adolescent Clinic2301 Beaver Avenue, Des Moines, IA 50310ComplianceOct 7, 2026

National Provider Directory

National Provider Directory

Locations

2785 N Ankeny Blvd
Ste 28
Ankeny, IA 50023

2301 Beaver Ave
Des Moines, IA 50310
Phone (515) 255-3181

Practitioners & affiliated clinicians

Practitioners 6

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": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1194991109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 BEAVER AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503103903",
            "telephone_number": "515-255-3181",
            "fax_number": "515-255-9392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 BEAVER AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503103903",
            "telephone_number": "515-255-3181",
            "fax_number": "515-255-9392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DES MOINES PEDIATRIC & ADOLESCENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "FORNOFF",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-255-3181",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.