NPIMap

Organization Active NPI

Broadlawns Medical Center

  • Anesthesiology Physician
  • Des Moines, IA
National Provider Identifier
1306068754
Registry record updated Sep 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
2785 Issued in IA
Legal business name
BROADLAWNS MEDICAL CENTER
Practice address
1801 Hickman Road
Des Moines, IA 50314-1548
Phone
(515) 282-2200
NPI assigned
May 3, 2007
Last updated
Sep 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2008

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

Authorized official

Name
Vincent J Mandracchia, DPM
Title
Chief Medical Officer
Phone
(515) 282-2562

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X 2785 IA Primary

Addresses

Primary practice location

1801 Hickman Road
Des Moines, IA 50314-1548

Mailing address

1801 Hickman Rd
Des Moines, IA 50314-1548
Phone (515) 282-2200

Other names 1

  • CRNA Other name

National Provider Directory

National Provider Directory
Tax ID family
Broadlawns Medical Cent16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222732800000",
    "number": "1306068754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 HICKMAN RD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503141548",
            "telephone_number": "515-282-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 HICKMAN ROAD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503141548",
            "telephone_number": "515-282-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADLAWNS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2008-09-30",
        "status": "A",
        "authorized_official_last_name": "MANDRACCHIA",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "515-282-2562",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "IA",
            "license": "2785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRNA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Sep 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.