NPIMap

Individual provider Active NPI

Thomas W. Fagg, D.O.

  • Family Medicine Physician
  • Jefferson, IA
National Provider Identifier
1235127481
Registry record updated May 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02388 Issued in IA
Practice address
1002 Lincoln Way
Jefferson, IA 50129
Phone
(515) 386-4192
Fax
(515) 386-3448
NPI assigned
Oct 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02388 IA Primary

Addresses

Primary practice location

1002 Lincoln Way
Jefferson, IA 50129

Mailing address

1002 Lincoln Way
Jefferson, IA 50129
Phone (515) 386-4192

Other identifiers 1

IdentifierTypeStateIssuer
0074856MedicaidIA

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
I20071207000680 IA Practitioner - Family PracticePractitioner - General PracticePractitioner - Emergency Medicine 9436248895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greene County Medical Center 16 clinicians

Practice addresses (Care Compare)

1000 W Lincoln Way
Jefferson, IA 50129-1645
Phone (515) 386-2488

Hospital & facility affiliations

  • Unitypoint at Home Home health agency, Urbandale, IA, CCN 167148
  • Hospice of the Midwest, LLC Hospice, Johnston, IA, CCN 161609
  • Greene County Medical Center Hospital, Jefferson, IA, CCN 161325

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02388IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greene County Medical Center Current Accepting new patients
Greene County Medical Center CurrentSince Dec 17, 2011 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients

Locations

1002 W Lincoln Way
Jefferson, IA 50129
Phone (515) 386-0500

1000 W Lincoln Way
Ste 100
Jefferson, IA 50129
Phone (515) 386-0500

1000 W Lincoln Way
Jefferson, IA 50129
Phone (515) 386-2114

Interoperability endpoints

  • Direct secure messaging: tfagg168117@direct.unitypoint.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Greene County Family MedicineJefferson, IA, CCN 168619 Rural health clinic W-2 Managing Employee
Operational/Managerial Control		 Jun 12, 2019
Jun 12, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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

Hospital & facility affiliations 3

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": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210896000000",
    "number": "1235127481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 LINCOLN WAY",
            "city": "JEFFERSON",
            "state": "IA",
            "postal_code": "50129",
            "telephone_number": "515-386-4192",
            "fax_number": "515-386-3448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 LINCOLN WAY",
            "city": "JEFFERSON",
            "state": "IA",
            "postal_code": "50129",
            "telephone_number": "515-386-4192",
            "fax_number": "515-386-3448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGG",
        "first_name": "THOMAS",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2008-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "02388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0074856",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, IA

Sources for this page

Verify at the official NPI Registry.