NPIMap

Organization Active NPI

Innovative Psychiatric Care PC

  • Specialist
  • Des Moines, IA
National Provider Identifier
1306949896
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
INNOVATIVE PSYCHIATRIC CARE PC
Practice address
3900 Ingersoll Ave
Suite 108
Des Moines, IA 50312-3534
Phone
(515) 279-6200
Fax
(515) 279-4528
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2007

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

Authorized official

Name
Dr. Loren A Olson, M.D.
Title
Owner
Phone
(515) 279-6200

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TB0200X
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

3900 Ingersoll Ave
Suite 108
Des Moines, IA 50312-3534

Mailing address

3900 Ingersoll Ave
Suite 108
Des Moines, IA 50312-3534
Phone (515) 279-6200

Other identifiers 1

IdentifierTypeStateIssuer
0249649MedicaidIA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1306949896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 INGERSOLL AVE",
            "address_2": "SUITE 108",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503123534",
            "telephone_number": "515-279-6200",
            "fax_number": "515-279-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 INGERSOLL AVE",
            "address_2": "SUITE 108",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503123534",
            "telephone_number": "515-279-6200",
            "fax_number": "515-279-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PSYCHIATRIC CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "LOREN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-279-6200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0249649",
            "state": "IA"
        }
    ],
    "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 Oct 30, 2007; 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.