Organization Active NPI

Distaff Professionals, LLC

  • Family Medicine Physician
  • Bloomfield, IA
National Provider Identifier
1265480040
Registry record updated Feb 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DISTAFF PROFESSIONALS, LLC
Practice address
607 W Jefferson St
Bloomfield, IA 52537-1516
Phone
(641) 664-3621
Fax
(641) 664-3690
NPI assigned
May 4, 2006
Last updated
Feb 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2010

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

Authorized official

Name
Dorothy Cline-Campbell, D.O.NPI 1568411817
Title
Manager
Phone
(641) 664-3621

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

607 W Jefferson St
Bloomfield, IA 52537-1516

Mailing address

PO Box 67
Bloomfield, IA 52537-0067
Phone (641) 664-3621

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040401000673 IA Part B Supplier - Clinic/Group Practice 1658363387 Receives reassigned benefits from 2 practitioners
Practice locations: Bloomfield, IA

National Provider Directory

National Provider Directory

Locations

607 W Jefferson St
Bloomfield, IA 52537
Phone (641) 664-3621

607 W Jefferson St
#67
Bloomfield, IA 52537

Practitioners & affiliated clinicians

Practitioners 3

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": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264982400000",
    "number": "1265480040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67",
            "city": "BLOOMFIELD",
            "state": "IA",
            "postal_code": "525370067",
            "telephone_number": "641-664-3621",
            "fax_number": "641-664-3690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W JEFFERSON ST",
            "city": "BLOOMFIELD",
            "state": "IA",
            "postal_code": "525371516",
            "telephone_number": "641-664-3621",
            "fax_number": "641-664-3690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTAFF PROFESSIONALS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2010-02-01",
        "status": "A",
        "authorized_official_last_name": "CLINE-CAMPBELL",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "641-664-3621",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; 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.