Individual provider Active NPI

Jacquelyn Susan Brungardt, ARNP

  • Nurse Practitioner
  • Des Moines, IA
National Provider Identifier
1255017869
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A174701 Issued in IA
Practice address
411 Laurel St Ste 2100
Des Moines, IA 50314-3026
Phone
(515) 247-3266
Fax
(515) 643-8688
NPI assigned
Jun 27, 2023
Last updated
Oct 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X A174701 IA Primary

Addresses

Primary practice location

411 Laurel St Ste 2100
Des Moines, IA 50314-3026

Mailing address

PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 247-3266

Other practice location 1

1111 6th Ave
Des Moines, IA 50314-2613
Phone (515) 247-3266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231013001240 IA Practitioner - Nurse Practitioner 2860847613 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinics IncGroup PAC ID 7911810882, 441 clinicians

Practice addresses (Care Compare)

411 Laurel St
Suite 2100
Des Moines, IA 50314-3026
Phone (515) 247-3266

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A174701IAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinics Inc CurrentSince Oct 8, 2023 Accepting new patients
Mercy Clinics, Inc. Nurse Practitioner Current Accepting new patients
Mercy Clinics, Inc. CurrentSince Oct 8, 2023 Accepting new patients

Locations

1111 6th Ave
Des Moines, IA 50314
Phone (515) 247-3121

330 Laurel St
Ste 1200
Des Moines, IA 50314
Phone (515) 643-5454

405 SW 5th St
Ste E
Des Moines, IA 50309
Phone (515) 358-7259

411 Laurel St
Ste 2100
Des Moines, IA 50314
Phone (515) 418-9960

Interoperability endpoints

  • Direct secure messaging: jbrungardt3940550@direct.trinity-health.org

Organizations & group practices 3

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 4

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": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1255017869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-247-3266",
            "fax_number": "515-643-8688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 LAUREL ST STE 2100",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503143026",
            "telephone_number": "515-247-3266",
            "fax_number": "515-643-8688"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503142613",
            "country_code": "US",
            "telephone_number": "515-247-3266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUNGARDT",
        "first_name": "JACQUELYN",
        "middle_name": "SUSAN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-27",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A174701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.