NPIMap

Organization Active NPI

Convenient Care Medical Group, PLLC

  • Physician Assistant
  • Council Bluffs, IA
National Provider Identifier
1336523893
Registry record updated Oct 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002355 Issued in IA
Legal business name
CONVENIENT CARE MEDICAL GROUP, PLLC
Practice address
3502 Metro Drive
Suite 200
Council Bluffs, IA 51501-7724
Phone
(712) 256-7172
Fax
(712) 256-7374
NPI assigned
Jul 15, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2015

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

Authorized official

Name
Wyatt Allen Schmidt, PA-CNPI 1215281282
Title
Physicain Assistant/Manager
Phone
(712) 256-7172

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 002355 IA Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X A121973 IA

Addresses

Primary practice location

3502 Metro Drive
Suite 200
Council Bluffs, IA 51501-7724

Mailing address

3502 Metro Drive
Suite 200
Council Bluffs, IA 51501-7724
Phone (712) 256-7172

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": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443744000000",
    "number": "1336523893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3502 METRO DRIVE",
            "address_2": "SUITE 200",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515017724",
            "telephone_number": "712-256-7172",
            "fax_number": "712-256-7374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 METRO DRIVE",
            "address_2": "SUITE 200",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515017724",
            "telephone_number": "712-256-7172",
            "fax_number": "712-256-7374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVENIENT CARE MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2015-10-02",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "WYATT",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PHYSICAIN ASSISTANT/MANAGER",
        "authorized_official_telephone_number": "712-256-7172",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "002355",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A121973",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; 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.