Active NPI
Glenace B Shank, D.O.
- Family Medicine Physician
- Urbandale, IA
National Provider Identifier
1386796530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 3154
- Practice address
- 2901 86TH St
Urbandale, IA 50322-4201 - Phone
- (515) 276-3406
- Fax
- (515) 276-5141
- NPI assigned
- Jan 17, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3154 | IA | Primary |
Addresses
Primary practice location
2901 86TH St
Urbandale, IA 50322-4201
Mailing address
2901 86TH St
Urbandale, IA 50322-4201
Phone (515) 276-3406
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38212 | Other | IA | WELLMARK BLUE CROSS |
| 1386796530 | Medicaid | IA | |
| 9163907 | Medicaid | IA | |
| P00267880 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3154 | IA | MD | Family Medicine Physician |
| 03154 | IA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Country Clinic Medical Services Inc | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Waukee, IA
- NPI 1396890158
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344470400000",
"number": "1386796530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 86TH ST",
"city": "URBANDALE",
"state": "IA",
"postal_code": "503224201",
"telephone_number": "515-276-3406",
"fax_number": "515-276-5141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 86TH ST",
"city": "URBANDALE",
"state": "IA",
"postal_code": "503224201",
"telephone_number": "515-276-3406",
"fax_number": "515-276-5141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANK",
"first_name": "GLENACE",
"middle_name": "B",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2012-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "3154",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK BLUE CROSS",
"identifier": "38212",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1386796530",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9163907",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00267880",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Urbandale, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.