West Broadway Clinic, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WEST BROADWAY CLINIC, PC

Practice address

16 S 17TH St
Council Bluffs, IA 51501-3818

Phone

(712) 256-5600

NPI assigned

Dec 28, 2007

Last updated

Dec 28, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Isam Elias Marar, M.D.NPI 1104976109

Title

President

Phone

(712) 256-5600

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/54bd9abd-9cf5-47af-bd4c-c4fcdbd30c2f/

Practitioners 4

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.

• Isam Elias Marar, M.D.

  • Internal Medicine Physician
  • Council Bluffs, IA
  • NPI 1104976109
  Medicare reassignment Care Compare group NPD Authorized official
• Diana Jeries Rabadi-Marar, M.D.

  • Internal Medicine Physician
  • Council Bluffs, IA
  • NPI 1366458945
  Medicare reassignment Care Compare group NPD
• Laura Quinnette, PA-C

  • Medical Physician Assistant
  • Council Bluffs, IA
  • NPI 1922458959
  Medicare reassignment
• Katie Drey, PA-C

  • Physician Assistant
  • Omaha, NE
  • NPI 1811489883

  IA

  Medicare reassignment

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

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1407031230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 S 17TH ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013818",
            "telephone_number": "712-256-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 S 17TH ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013818",
            "telephone_number": "712-256-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST BROADWAY CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-28",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "MARAR",
        "authorized_official_first_name": "ISAM",
        "authorized_official_middle_name": "ELIAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-256-5600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Lynn Wellman, ARNP
• Lavaughn Wells
• Melanie Jo Wells, LISW, LMSW
• West Broadway Clinic, P.C.
• West Broadway Clinic, P.C.
• Gina West-Hendrickson
• Western Iowa Dental Group, LLC
• Western Iowa Dental Group,PC (Bayliss Park Dental Group)
• Sheila Mary Wettengel, RPH
• William L Wettengel, RPH

• Internal Medicine Physician in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Internal Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; 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.