NPIMap

Organization Active NPI

Iowa Radiology, P C

  • Diagnostic Radiology Physician
  • Clive, IA
National Provider Identifier
1336107283
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
IOWA RADIOLOGY, P C
Practice address
12368 Stratford Dr
Suite 300
Clive, IA 50325-8162
Phone
(515) 226-9810
Fax
(515) 226-8408
NPI assigned
May 2, 2006
Last updated
Nov 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

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

Authorized official

Name
Penny Shepherd
Title
Billing Office Manager
Phone
(515) 226-7426

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X NU
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

12368 Stratford Dr
Suite 300
Clive, IA 50325-8162

Mailing address

12368 Stratford Dr
Suite 300
Clive, IA 50325-8162
Phone (515) 226-9810

Other identifiers 1

IdentifierTypeStateIssuer
0230813MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, MO, LA, MN, AK, OK, HI, KS, FL, NE10 enrollments

Enrollment records 10

Enrollment IDStateProvider typePAC IDDetails
O20040324001052 IA Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 36 practitioners
Practice locations: West Des Moines, IA; Storm Lake, IA; Sac City, IA; Pocahontas, IA; Osceola, IA; Nevada, IA; Lake City, IA; Jefferson, IA…
O20170413000850 MO Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 1 practitioner
Practice locations: Marshfield, MO
O20180328001596 LA Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 1 practitioner
Practice locations: Mandeville, LA
O20181008000882 MN Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 1 practitioner
Practice locations: Woodbury, MN
O20181016000362 AK Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 1 practitioner
Practice locations: Wasilla, AK
O20221004003428 OK Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 1 practitioner
Practice locations: Poteau, OK
O20221117002733 HI Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 1 practitioner
Practice locations: Honolulu, HI
O20250116000708 KS Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 1 practitioner
Practice locations: Leawood, KS
O20250528000354 FL Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 2 practitioners
Practice locations: Bonita Springs, FL
O20260520003161 NE Part B Supplier - Clinic/Group Practice 2264323468 Receives reassigned benefits from 1 practitioner
Practice locations: Bennington, NE

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

12368 Stratford Dr
Ste 300
Des Moines, IA 50325
Phone (515) 228-9810

6000 University Ave
West Des Moines, IA 50266
Phone (515) 241-2100

1500 S Broadway Ave
Poteau, OK 74953

Practitioners & affiliated clinicians

Practitioners 50

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.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1336107283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12368 STRATFORD DR",
            "address_2": "SUITE 300",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258162",
            "telephone_number": "515-226-9810",
            "fax_number": "515-226-8408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12368 STRATFORD DR",
            "address_2": "SUITE 300",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258162",
            "telephone_number": "515-226-9810",
            "fax_number": "515-226-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IOWA RADIOLOGY, P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "PENNY",
        "authorized_official_title_or_position": "BILLING OFFICE MANAGER",
        "authorized_official_telephone_number": "515-226-7426"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0230813",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.