Active NPI
James G Kannenberg, M.D.
- Family Medicine Physician
- Fort Madison, IA
National Provider Identifier
1265434864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 22910
- Practice address
- 5409 Avenue O
Fort Madison, IA 52627-9601 - Phone
- (319) 376-2134
- Fax
- (319) 376-2188
- NPI assigned
- Aug 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 22910 | IA | Primary |
Addresses
Primary practice location
5409 Avenue O
Fort Madison, IA 52627-9601
Mailing address
5409 Avenue O
Fort Madison, IA 52627-9601
Phone (319) 376-2134
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194928 | Medicaid | IA | |
| 25668 | Other | IA | IOWA HEALTH SOLUTIONS |
| 45020 | Other | IA | WELLMARK BLUE CROSS |
| IA0122 | Other | IA | JOHN DEERE HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Iowa Regional Medical Center, Inc. | Past | Accepting new patients | |
| Prairie Trails Emergency Physicians | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Corydon, IA
- NPI 1972894665
-
- General Practice Physician
- West Burlington, IA
- NPI 1164433884
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185926400000",
"number": "1265434864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5409 AVENUE O",
"city": "FORT MADISON",
"state": "IA",
"postal_code": "526279601",
"telephone_number": "319-376-2134",
"fax_number": "319-376-2188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5409 AVENUE O",
"city": "FORT MADISON",
"state": "IA",
"postal_code": "526279601",
"telephone_number": "319-376-2134",
"fax_number": "319-376-2188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANNENBERG",
"first_name": "JAMES",
"middle_name": "G",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-12",
"last_updated": "2007-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "22910",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1194928",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IOWA HEALTH SOLUTIONS",
"identifier": "25668",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK BLUE CROSS",
"identifier": "45020",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE HEALTH",
"identifier": "IA0122",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Madison, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.