NPIMap

Individual provider Active NPI

Lydia Mustafic, M.D.

  • Family Medicine Physician
  • Waterloo, IA
National Provider Identifier
1386879724
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
44461 Issued in KY
Practice address
2710 Saint Francis Dr Ste 210
Waterloo, IA 50702-5664
Phone
(319) 272-5000
NPI assigned
May 28, 2009
Sex
Female
Sole proprietor
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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 44461 KY Primary

Addresses

Primary practice location

2710 Saint Francis Dr Ste 210
Waterloo, IA 50702-5664

Mailing address

1306 Versailles Rd
Ste 120
Lexington, KY 40504-1796
Phone (859) 259-0717

Other practice location 1

1306 Versailles Rd
Ste 120
Lexington, KY 40504-1796
Phone (859) 259-0717

Other identifiers 1

IdentifierTypeStateIssuer
7100179770MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131023001057 IA Practitioner - Family Practice 9335311182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kentucky College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Center IncGroup PAC ID 0244148732, 234 clinicians

Practice addresses (Care Compare)

226 Bluebell Rd
Cedar Falls, IA 50613-6328
Phone (319) 575-5800

2710 Saint Francis Dr
Waterloo, IA 50702-5619
Phone (319) 272-5000

2710 Saint Francis Dr
Waterloo, IA 50702-5664

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
44461KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Center Inc Family Medicine CurrentSince Aug 26, 2013 Accepting new patients
Covenant Medical Center, Inc. CurrentSince Aug 26, 2013 Accepting new patients
Floyd County Memorial Hospital Commission Family Medicine Past Accepting new patients

Locations

751 Main St
Arlington, IA 50606
Phone (563) 633-6965

226 Bluebell Rd
Cedar Falls, IA 50613
Phone (319) 575-5800

3421 W 9th St
Waterloo, IA 50702
Phone (319) 272-7050

2710 Saint Francis Dr
Ste 210
Waterloo, IA 50702
Phone (319) 272-5242

Interoperability endpoints

  • Direct secure messaging: lmustafic3935001@direct.trinity-health.org

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1243468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1386879724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 VERSAILLES RD",
            "address_2": "STE 120",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405041796",
            "telephone_number": "859-259-0717",
            "fax_number": "859-254-7874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 SAINT FRANCIS DR STE 210",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025664",
            "telephone_number": "319-272-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1306 Versailles Rd",
            "address_2": "Ste 120",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405041796",
            "country_code": "US",
            "telephone_number": "859-259-0717",
            "fax_number": "859-254-7874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUSTAFIC",
        "first_name": "LYDIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "44461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100179770",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.