NPIMap

Organization Active NPI

Creston Medical Clinic, P.C.

  • Certified Registered Nurse Anesthetist
  • Creston, IA
National Provider Identifier
1316991607
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
CRESTON MEDICAL CLINIC, P.C.
Practice address
1610 W Townline St
Suite 200
Creston, IA 50801-1066
Phone
(641) 782-2131
Fax
(641) 782-6425
NPI assigned
May 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
James E Mansour, M.D.NPI 1053365395
Title
President of the Corporation
Phone
(641) 782-2131

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X Primary

Addresses

Primary practice location

1610 W Townline St
Suite 200
Creston, IA 50801-1066

Mailing address

1610 W Townline St
Suite 200
Creston, IA 50801-1066
Phone (641) 782-2131

Other identifiers 2

IdentifierTypeStateIssuer
26579OtherIAWELLMARK BCBS CRNA #
0265793MedicaidIA

Other names 1

  • Creston Medical Clinic CRNAs Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316991607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 W TOWNLINE ST",
            "address_2": "SUITE 200",
            "city": "CRESTON",
            "state": "IA",
            "postal_code": "508011066",
            "telephone_number": "641-782-2131",
            "fax_number": "641-782-6425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 W TOWNLINE ST",
            "address_2": "SUITE 200",
            "city": "CRESTON",
            "state": "IA",
            "postal_code": "508011066",
            "telephone_number": "641-782-2131",
            "fax_number": "641-782-6425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTON MEDICAL CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT OF THE CORPORATION",
        "authorized_official_telephone_number": "641-782-2131",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS CRNA #",
            "identifier": "26579",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0265793",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creston Medical Clinic CRNAs",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Creston, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.