Active NPI
Dustin M Rockwell, PTA
- Skilled Nursing Facility
- Logan, IA
National Provider Identifier
1316215205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 004852
- Practice address
- 314 S Elm Ave
Logan, IA 51546-1442 - Phone
- (712) 644-2922
- NPI assigned
- Dec 6, 2011
- Last updated
- Dec 6, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 004852 | IA | Primary |
Addresses
Primary practice location
314 S Elm Ave
Logan, IA 51546-1442
Mailing address
5320 N St
Omaha, NE 68117-1837
Phone (970) 497-0251
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004852 | IA | MD | Skilled Nursing Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1316215205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5320 N ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681171837",
"telephone_number": "970-497-0251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "314 S ELM AVE",
"city": "LOGAN",
"state": "IA",
"postal_code": "515461442",
"telephone_number": "712-644-2922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROCKWELL",
"first_name": "DUSTIN",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-06",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IA",
"license": "004852",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.