NPIMap

Organization Active NPI

La Clinica Medica Latina of Des Moines LLC

  • Nurse Practitioner
  • Des Moines, IA
National Provider Identifier
1306965348
Registry record updated Mar 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A098023 Issued in IA
Legal business name
LA CLINICA MEDICA LATINA OF DES MOINES LLC
Practice address
1300 Des Moines St
Suite 106
Des Moines, IA 50309-5502
Phone
(515) 265-8200
Fax
(515) 262-0045
NPI assigned
Mar 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2011

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

Authorized official

Name
Ava Eagles, ARNP
Title
Clinic Operations MGR Co Owner
Phone
(515) 265-8200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25966 IA
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X A098023 IA Primary

Addresses

Primary practice location

1300 Des Moines St
Suite 106
Des Moines, IA 50309-5502

Mailing address

2213 Grand Ave
Des Moines, IA 50312-5305
Phone (515) 237-3974

Other identifiers 3

IdentifierTypeStateIssuer
DN6229OtherIARAILROAD MEDICARE
0785931MedicaidIA
0785956MedicaidIA

National Provider Directory

National Provider Directory

Locations

3231 E Euclid Ave
Ste 100
Des Moines, IA 50317
Phone (515) 262-6035

1300 Des Moines St
Ste 106
Des Moines, IA 50309
Phone (515) 265-8200

Practitioners & affiliated clinicians

Practitioners 3

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": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300838400000",
    "number": "1306965348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2213 GRAND AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503125305",
            "telephone_number": "515-237-3974",
            "fax_number": "515-883-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 DES MOINES ST",
            "address_2": "SUITE 106",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503095502",
            "telephone_number": "515-265-8200",
            "fax_number": "515-262-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA MEDICA LATINA OF DES MOINES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2011-03-23",
        "status": "A",
        "authorized_official_last_name": "EAGLES",
        "authorized_official_first_name": "AVA",
        "authorized_official_title_or_position": "CLINIC OPERATIONS MGR CO OWNER",
        "authorized_official_telephone_number": "515-265-8200",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "25966",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A098023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DN6229",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0785931",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0785956",
            "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 Mar 23, 2011; 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.