Advanced Spine and Rehab Center PC
Organization Active NPI Family Medicine Physician · Cedar Rapids, IA
NPI 1386785293 · NPPES record last updated Feb 2, 2016
Key facts
- NPI
- 1386785293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ADVANCED SPINE AND REHAB CENTER PC
- Practice address
- 4205 Glass Rd NE
Cedar Rapids, IA 52402-2514 - Phone
- (319) 294-0094
- Fax
- (319) 294-0095
- NPI assigned
- Feb 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeffrey Alan Mitchell, D.C.
- Title
- President
- Phone
- (319) 981-2292
Practitioners 9
-
Michelle Ann Donohue, ARNP
-
Megan Elizabeth Gilmere, ACNPC-AG
-
Timothy J. Miller, M.D.
-
Jeffrey Alan Mitchell, D.C.
-
Olivia Parmelee, DC
-
John Eikenberry, PT, LAT
-
Melissa Anne Janssen, ANRP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D2022914 | Advanced Spine & Rehab Center, PC Laboratory | Certificate of waiver | Apr 11, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Cedar Rapids Pain Associates PC |
Traction Equipment|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070219000671 | IA | Part B Supplier - Clinic/Group Practice | 8820190069 |
Receives reassigned benefits from 8 practitioners Practice locations: Cedar Rapids, IA |
| O20100930072250 | IA | DME Supplier - Medical Supply Company |
8820190069 | Practice locations: Cedar Rapids, IA |
National Provider Directory
Locations
4205 Glass Rd NE
Ste 524
Cedar Rapids, IA 52402
1110 Old Marion Rd NE
Ste 2
Cedar Rapids, IA 52402
Phone (319) 378-8046
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72613
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 6916 | IA | |
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | 27216 | IA | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | IA | ||
| Nurse Practitioner |
363L00000X | 110073 | IA |
Addresses
Primary practice location
4205 Glass Rd NE
Cedar Rapids, IA 52402-2514
Mailing address
4205 Glass Rd NE
Cedar Rapids, IA 52402-2514
Phone (319) 294-0094
Other providers in Cedar Rapids, IA
- Barth David Adolphson
- Rebekah Ann Adolphson
- Adrian P Rehak, DDS, PC
- Advanced Center for Electrolysis & Laser, LLC
- Advanced Dental Care, PC
- Advantage Chiropractic, PLLC
- Affiliates of Family Practice of Cedar Rapids
- Affordable Dentures - Cedar Rapids, P.C.
- Affordable Dentures & Implants - Cedar Rapids III, P.C.
- Affordable Dentures & Implants - Cedar Rapids IV, P.C.
All providers in Cedar Rapids, IA · Family Medicine Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.