NPIMap

Organization Active NPI

Family Medicine Clinic, P.C.

  • Family Medicine Physician
  • Onawa, IA
National Provider Identifier
1386824787
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY MEDICINE CLINIC, P.C.
Practice address
1614 Diamond Street PL
Onawa, IA 51040-1554
Phone
(712) 423-1525
Fax
(712) 423-2528
NPI assigned
Nov 14, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Paul Edward Dudley, MDNPI 1194721332
Title
President
Phone
(712) 423-1525

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X IA Primary

Addresses

Primary practice location

1614 Diamond Street PL
Onawa, IA 51040-1554

Mailing address

1614 Diamond Street PL
Onawa, IA 51040-1554
Phone (712) 423-1525

Other identifiers 2

IdentifierTypeStateIssuer
0064204MedicaidIA
06420OtherIABLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040313000752 IA Part B Supplier - Clinic/Group Practice 0547159824 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Onawa, IA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386824787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 DIAMOND STREET PL",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510401554",
            "telephone_number": "712-423-1525",
            "fax_number": "712-423-2528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 DIAMOND STREET PL",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510401554",
            "telephone_number": "712-423-1525",
            "fax_number": "712-423-2528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-423-1525",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0064204",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "06420",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Onawa, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.