NPIMap

Organization Active NPI

Pet Co LLC

  • Body Imaging Physician
  • Des Moines, IA
National Provider Identifier
1285627943
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
PET CO LLC
Practice address
1221 Pleasant St
Ste 150a
Des Moines, IA 50309
Phone
(515) 244-5109
Fax
(515) 241-3505
NPI assigned
Aug 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Mr. C. Edward Brown
Title
Chief Executive Officer
Phone
(515) 875-9100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085B0100X Primary

Addresses

Primary practice location

1221 Pleasant St
Ste 150a
Des Moines, IA 50309

Mailing address

7147 Vista Dr Ste 160
West Des Moines, IA 50266-9313
Phone (515) 875-9924

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000467 IA Part B Supplier - Clinic/Group Practice 3870485642 Receives reassigned benefits from 8 practitioners
Practice locations: Ankeny, IA; Des Moines, IA

National Provider Directory

National Provider Directory
Tax ID family
Pet Co2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1125273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1285627943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7147 VISTA DR STE 160",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502669313",
            "telephone_number": "515-875-9924",
            "fax_number": "515-875-9923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 PLEASANT ST",
            "address_2": "STE 150A",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "50309",
            "telephone_number": "515-244-5109",
            "fax_number": "515-241-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PET CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-29",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "C.",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "515-875-9100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.