NPIMap

Individual provider Active NPI

Pratibha Dua, MD

  • Internal Medicine Physician
  • Waterloo, IA
National Provider Identifier
1235116369
Registry record updated May 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35236 Issued in IA
Practice address
1717 W Ridgeway Ave
Waterloo, IA 50701-4543
Phone
(319) 833-5700
Fax
(319) 833-5740
NPI assigned
Dec 29, 2005
Last updated
May 22, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35236 IA Primary

Addresses

Primary practice location

1717 W Ridgeway Ave
Waterloo, IA 50701-4543

Mailing address

1717 W Ridgeway Ave
Waterloo, IA 50701-4543
Phone (319) 833-5700

Other identifiers 3

IdentifierTypeStateIssuer
1235116369MedicaidIA
0422949MedicaidIA
P00066566OtherIARR MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040218000426 IA Practitioner - Internal Medicine 3678468717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1996
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4480 Utica Ridge Rd
Suite 2230
Bettendorf, IA 52722-1644
Phone (563) 742-5150

8101 Birchwood CT
Unit R
Johnston, IA 50131-2930

PO Box
Suite 1455
Des Moines, IA 50306-1455

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation Internal Medicine CurrentSince Dec 1, 2003 Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients
Iowa Physicians Clinic Medical Foundation PastSince Jan 1, 1990 Accepting new patients
Iowa Physicians Clinic Medical Foundation PastSince Jan 1, 1990 Accepting new patients
Iowa Physicians Clinic Medical Foundation PastSince Jan 1, 1990 Accepting new patients
Iowa Physicians Clinic Medical Foundation PastSince Jan 1, 1990 Accepting new patients
Trinity Medical Center Internal Medicine Past Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

1717 W Ridgeway Ave
Waterloo, IA 50701
Phone (319) 233-0340

2140 Logan Ave
Ste A
Waterloo, IA 50703
Phone (319) 226-8430

Interoperability endpoints

  • Direct secure messaging: pdua108193@direct.unitypoint.org

Organizations & group practices 8

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 8

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": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337644800000",
    "number": "1235116369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 W RIDGEWAY AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507014543",
            "telephone_number": "319-833-5700",
            "fax_number": "319-833-5740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 W RIDGEWAY AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507014543",
            "telephone_number": "319-833-5700",
            "fax_number": "319-833-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUA",
        "first_name": "PRATIBHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-29",
        "last_updated": "2012-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "35236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235116369",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0422949",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00066566",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.