NPIMap

Organization Active NPI

Family & Specialty Medical Center PC

  • Family Medicine Physician
  • Carroll, IA
National Provider Identifier
1386665461
Registry record updated Oct 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3267 Issued in IA
Legal business name
FAMILY & SPECIALTY MEDICAL CENTER PC
Practice address
515 N Main St
Carroll, IA 51401-2739
Phone
(712) 792-4000
Fax
(712) 792-7773
NPI assigned
Jul 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2014

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

Authorized official

Name
Danette M Fox
Title
Credentialing
Phone
(712) 792-4000

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 3267 IA Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 02754 IA
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X 000745 IA

Addresses

Primary practice location

515 N Main St
Carroll, IA 51401-2739

Mailing address

515 N Main St
Carroll, IA 51401-2739
Phone (712) 792-4000

Other identifiers 1

IdentifierTypeStateIssuer
CH4508OtherIARAILROAD MEDICARE GROUP #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040329001688 IA Part B Supplier - Clinic/Group Practice 5092607309 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
Practice locations: Carroll, IA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

515 N Main St
Carroll, IA 51401
Phone (712) 792-4000

503 N Main St
Carroll, IA 51401
Phone (712) 792-3528

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412812800000",
    "number": "1386665461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 N MAIN ST",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514012739",
            "telephone_number": "712-792-4000",
            "fax_number": "712-792-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N MAIN ST",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514012739",
            "telephone_number": "712-792-4000",
            "fax_number": "712-792-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY & SPECIALTY MEDICAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2014-10-09",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "DANETTE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "712-792-4000"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "3267",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "02754",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "000745",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "CH4508",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carroll, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; 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.