NPIMap

Organization Active NPI

Mercy Care Management, Inc

  • Family Medicine Physician
  • Cedar Rapids, IA
National Provider Identifier
1306042890
Registry record updated Nov 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MERCY CARE MANAGEMENT, INC
Practice address
2815 Edgewood Rd SW
Cedar Rapids, IA 52404-3258
Phone
(319) 369-4798
NPI assigned
Jun 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2018

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

Authorized official

Name
Mr. Timothy L Charles
Title
President and Ceo
Phone
(319) 398-6697

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

2815 Edgewood Rd SW
Cedar Rapids, IA 52404-3258

Mailing address

PO Box 786
Cedar Rapids, IA 52406-0786

Other identifiers 2

IdentifierTypeStateIssuer
0794263MedicaidIA
0794255MedicaidIA

Other names 1

  • Mercy Care South Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040322000692 IA Part B Supplier - Clinic/Group Practice 2466343363 Receives reassigned benefits from 79 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cedar Rapids, IA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0980778Mercy Care South2815 Edgewood Road SW, Cedar Rapids, IA 52404Certificate of waiverApr 6, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

375 Collins Rd NE
Cedar Rapids, IA 52402
Phone (319) 393-0222

Practitioners & affiliated clinicians

Practitioners 54

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

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541030400000",
    "number": "1306042890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 786",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524060786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2815 EDGEWOOD RD SW",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524043258",
            "telephone_number": "319-369-4798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CARE MANAGEMENT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-22",
        "last_updated": "2018-11-01",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "319-398-6697",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0794263",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0794255",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Care South",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Care South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.