NPIMap

Organization Active NPI

Meditelecare of Iowa PLLC

  • Psychologist
  • Des Moines, IA
National Provider Identifier
1386146678
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MEDITELECARE OF IOWA PLLC
Practice address
400 E Court Ave Ste 110
Des Moines, IA 50309-2027
Phone
(860) 788-6404
Fax
(860) 829-0495
NPI assigned
Mar 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Authorized official

Name
Andrea Godfrey
Title
Credentialing & Enrollment Manager
Phone
(860) 398-6441

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Geriatric Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0805X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

400 E Court Ave Ste 110
Des Moines, IA 50309-2027

Mailing address

PO Box 1595
Middletown, CT 06457-8095
Phone (860) 788-6404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180329001998 IA Part B Supplier - Clinic/Group Practice 0446512503 Receives reassigned benefits from 12 practitioners
Practice locations: West Union, IA; Waukon, IA; Oelwein, IA; Bloomfield, IA; North English, IA; Newell, IA; Mount Pleasant, IA; Mount Ayr, IA…

National Provider Directory

National Provider Directory

Locations

508 W Pearl St
#2
Afton, IA 50830

1300 E 19th St
#4
Atlantic, IA 50022

1005 Pearl St
#5
Bedford, IA 50833

800 N Davis St
#6
Bloomfield, IA 52537

1208 E Cross St
#8
Centerville, IA 52544

1214 N 7th St
#9
Chariton, IA 50049

202 Jefferson St
#10
Clearfield, IA 50840

1614 Northgate Dr
#12
Corning, IA 50841

745 E South St
#13
Corydon, IA 50060

701 Vernon Rd
#1
Cresco, IA 52136

1000 E Howard St
#14
Creston, IA 50801

324 1st Ave N
#19
George, IA 51237

1700 3rd St NE
#16
Independence, IA 50644

406 W Washington St
#11
Mount Ayr, IA 50854

701 E Mapleleaf Dr
#3
Mount Pleasant, IA 52641

150 W Washington St
#16
North English, IA 52316

800 5th St SE
#22
Oelwein, IA 50662

21 E Main St
#21
Waukon, IA 52172

201 Hall St
#21
West Union, IA 52175

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1386146678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1595",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064578095",
            "telephone_number": "860-788-6404",
            "fax_number": "860-829-0495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E COURT AVE STE 110",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503092027",
            "telephone_number": "860-788-6404",
            "fax_number": "860-829-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDITELECARE OF IOWA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-02",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A",
        "authorized_official_last_name": "GODFREY",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CREDENTIALING & ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "860-398-6441"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; 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.