Active NPI
Charles Scott Jennisch, MD
- Psychiatry Physician
- Urbandale, IA
National Provider Identifier
1225133606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 32533
- Practice address
- 6921 Hickman Rd Ste 2327
Urbandale, IA 50322-4805 - Phone
- (515) 270-2242
- NPI assigned
- Sep 13, 2006
- Last updated
- Jul 24, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 32533 | IA | Primary |
Addresses
Primary practice location
6921 Hickman Rd Ste 2327
Urbandale, IA 50322-4805
Mailing address
6921 Hickman Rd Ste 2327
Urbandale, IA 50322-4805
Phone (515) 270-2242
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21492 | Other | IA | WELLMARK |
| 1213199 | Medicaid | IA |
Other names 1
- C Scott Jennisch
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 23, 2015 through Feb 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iowa Psychiatry, LLC | Psychiatry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychiatry Physician
- Urbandale, IA
- NPI 1033525902
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406160000000",
"number": "1225133606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6921 HICKMAN RD STE 2327",
"city": "URBANDALE",
"state": "IA",
"postal_code": "503224805",
"telephone_number": "515-270-2242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6921 HICKMAN RD STE 2327",
"city": "URBANDALE",
"state": "IA",
"postal_code": "503224805",
"telephone_number": "515-270-2242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNISCH",
"first_name": "CHARLES",
"middle_name": "SCOTT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-13",
"last_updated": "2014-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IA",
"license": "32533",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK",
"identifier": "21492",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1213199",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "C",
"last_name": "JENNISCH",
"middle_name": "SCOTT",
"credential": "MD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Urbandale, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2014; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.