Clinton Keith Cunningham

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

087027 Issued in IA

Practice address

405 Monroe St
Pella, IA 50219-1290

Phone

(641) 621-2200

Fax

(641) 621-2335

NPI assigned

Sep 11, 2018

Last updated

Oct 13, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Ankeny Family CounselingGroup PAC ID 6103364666, 5 clinicians

QV Urgent Care Ia PLLCGroup PAC ID 1052722147, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ankeny Family Counseling

  • Mental Health Counselor
  • Ankeny, IA
  • NPI 1053804617
  Medicare reassignment Care Compare group NPD
• QV Urgent Care Ia PLLC

  dba QuickVisit Urgent Care

  • Urgent Care Clinic/Center
  • Mt Pleasant, IA
  • NPI 1407465917
  Medicare reassignment Care Compare group NPD
• Pella Regional Health Center

  • Critical Access Hospital
  • Pella, IA
  • NPI 1578520888
  Medicare reassignment NPD
• QV Urgent Care Ia PLLC

  dba Quickvisit Urgent Care

  • Rural Health Clinic/Center
  • Washington, IA
  • NPI 1235835950
  NPD
• Healthsource of Cedar Rapids SW, LLC

  • Chiropractor
  • Cedar Rapids, IA
  • NPI 1114295284
  NPD (past)

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728777600000",
    "number": "1215410741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 MONROE ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191290",
            "telephone_number": "641-621-2200",
            "fax_number": "641-621-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 MONROE ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191290",
            "telephone_number": "641-621-2200",
            "fax_number": "641-621-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "CLINTON",
        "middle_name": "KEITH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-11",
        "last_updated": "2024-10-13",
        "certification_date": "2024-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IA",
            "license": "087027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "LMFT-16160",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA LICENSE",
            "identifier": "087027",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI #",
            "identifier": "1215410741",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LMFT-16160",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA LICENSE",
            "identifier": "007829",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "prhc@direct.pellahealth.kobledirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "405 Monroe St",
            "city": "Pella",
            "state": "IA",
            "country_code": "US",
            "postal_code": "502191290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kameshni Cornelius, PA
• Andrew Cowles
• Michael Scott Cranmer Jr.
• Malea Crimmins, OT
• Allysa Anne Criss
• Dahm Dental, P.C.
• Jeffrey P Dahm
• David Daining, MD
• Shelby Dames, M.D.
• Darla Joy De Haan, MA

• Marriage & Family Therapist in Pella, IA
• Providers in Pella, IA by specialty
• Marriage & Family Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2024; 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.

Verify at the official NPI Registry.