NPIMap

Individual provider Active NPI

Jodi L Stowater-Goodrich, PA

  • Medical Physician Assistant
  • Council Bluffs, IA
National Provider Identifier
1225278609
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
002206 Issued in IA
Practice address
1288 Valley View Dr
Council Bluffs, IA 51503-5245
Phone
(712) 328-8800
Fax
(712) 328-8461
NPI assigned
Feb 25, 2009
Last updated
May 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1430 NE
Medical Physician Assistant 363AM0700X 002206 IA Primary

Addresses

Primary practice location

1288 Valley View Dr
Council Bluffs, IA 51503-5245

Mailing address

1288 Valley View Dr
Council Bluffs, IA 51503-5245
Phone (712) 328-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090317000132 NE Practitioner - Physician Assistant 6002973104 Reassigns benefits to 1 organization
I20120227000499 IA Practitioner - Physician Assistant 6002973104 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, 951 clinicians

Practice addresses (Care Compare)

800 Mercy Dr
Council Bluffs, IA 51503-3128

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
002206IAMDMedical Physician Assistant
1430NEMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic CurrentSince Feb 15, 2022 Accepting new patients
Alegent Creighton Clinic CurrentSince Feb 15, 2022 Accepting new patients

Locations

800 Mercy Dr
Ste 220
Council Bluffs, IA 51503
Phone (712) 388-2660

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1235520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1225278609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1288 VALLEY VIEW DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515035245",
            "telephone_number": "712-328-8800",
            "fax_number": "712-328-8461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1288 VALLEY VIEW DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515035245",
            "telephone_number": "712-328-8800",
            "fax_number": "712-328-8461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOWATER-GOODRICH",
        "first_name": "JODI",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-25",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NE",
            "license": "1430",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "002206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.