Individual provider Active NPI

D Pierre Gingerich-Boberg, MD, MD

  • Family Medicine Physician
  • Waterloo, IA
National Provider Identifier
1295186328
Registry record updated Aug 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R107029 Issued in IA
Practice address
2055 Kimball Ave Ste 101
Waterloo, IA 50702-5047
Phone
(319) 272-2112
Fax
(319) 272-2107
NPI assigned
Jun 30, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R107029 IA Primary

Addresses

Primary practice location

2055 Kimball Ave Ste 101
Waterloo, IA 50702-5047

Mailing address

2055 Kimball Ave Ste 101
Waterloo, IA 50702-5047
Phone (319) 272-2112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200529000245 MN Practitioner - Family Practice 8426343856

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R107029IAMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472515200000",
    "number": "1295186328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 KIMBALL AVE STE 101",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025047",
            "telephone_number": "319-272-2112",
            "fax_number": "319-272-2107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 KIMBALL AVE STE 101",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025047",
            "telephone_number": "319-272-2112",
            "fax_number": "319-272-2107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GINGERICH-BOBERG, MD",
        "first_name": "D",
        "middle_name": "PIERRE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-30",
        "last_updated": "2016-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R107029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.