Active NPI
Oliver M Ancheta, M.D.
- Neurology Physician
- Clinton, IA
National Provider Identifier
1366400327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 25490
- Practice address
- 915 13TH Ave N
Clinton, IA 52732-5067 - Phone
- (563) 243-2511
- Fax
- (563) 243-0817
- NPI assigned
- May 1, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 25490 | IA | Primary |
Addresses
Primary practice location
915 13TH Ave N
Clinton, IA 52732-5067
Mailing address
915 13TH Ave N
Clinton, IA 52732-5067
Phone (563) 243-2511
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 018401 | Other | HEALTH ALLIANCE | |
| 20303 | Other | WELLMARK BC/BS | |
| A57002 | Other | JOHN DEERE HEALTH | |
| 14801 | Other | MIDLANDS CHOICE | |
| 0038265 | Medicaid | IA | |
| 27210 | Other | IOWA HEALTH SOLUTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091207000017 | IA | Practitioner - Neurology | 1456441690 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25490 | IA | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Health System | Current | Accepting new patients | |
| Genesis Health System | Current | Accepting new patients |
Locations
4700 E 56th St
Ste 100
Davenport, IA 52807
Phone (563) 383-2667
1351 W Central Park Ave
Ste 340
Davenport, IA 52804
Phone (563) 421-1287
1351 W Central Park Ave
Ste 3300
Davenport, IA 52804
Phone (563) 383-2667
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Silvis, IL
- NPI 1427132604
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363305600000",
"number": "1366400327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "915 13TH AVE N",
"city": "CLINTON",
"state": "IA",
"postal_code": "527325067",
"telephone_number": "563-243-2511",
"fax_number": "563-243-0817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 13TH AVE N",
"city": "CLINTON",
"state": "IA",
"postal_code": "527325067",
"telephone_number": "563-243-2511",
"fax_number": "563-243-0817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANCHETA",
"first_name": "OLIVER",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-01",
"last_updated": "2013-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "IA",
"license": "25490",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "018401",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK BC/BS",
"identifier": "20303",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE HEALTH",
"identifier": "A57002",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS CHOICE",
"identifier": "14801",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0038265",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IOWA HEALTH SOLUTIONS",
"identifier": "27210",
"state": null
}
],
"endpoints": [],
"other_names": []
}
Other providers in Clinton, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.