NPIMap

Organization Active NPI

Mercy Specialty Clinic

Doing business as MercyOne DeWitt Family Medicine

  • Family Medicine Physician
  • De Witt, IA
National Provider Identifier
1235793829
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MERCY SPECIALTY CLINIC
Doing business as
MercyOne DeWitt Family Medicine
Practice address
1021 11TH St
De Witt, IA 52742-1209
Phone
(563) 659-9294
Fax
(563) 659-8104
NPI assigned
Apr 29, 2019
Last updated
Feb 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Authorized official

Name
April Joan Glazier
Title
Clinic Manager
Phone
(563) 244-7387

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1021 11TH St
De Witt, IA 52742-1209

Mailing address

621 S Illinois Ave Ste 103
Mason City, IA 50401-5489
Phone (641) 428-3900

Other names 1

  • MercyOne DeWitt Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071019000139 IA Part B Supplier - Clinic/Group Practice 3375639586 Receives reassigned benefits from 191 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, IA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1021 11th St
De Witt, IA 52742
Phone (563) 659-9294

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1235793829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S ILLINOIS AVE STE 103",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504015489",
            "telephone_number": "641-428-3900",
            "fax_number": "641-428-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 11TH ST",
            "city": "DE WITT",
            "state": "IA",
            "postal_code": "527421209",
            "telephone_number": "563-659-9294",
            "fax_number": "563-659-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY SPECIALTY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-29",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "GLAZIER",
        "authorized_official_first_name": "APRIL",
        "authorized_official_middle_name": "JOAN",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "563-244-7387"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MercyOne DeWitt Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MercyOne DeWitt Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Witt, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.