NPIMap

Organization Active NPI

Great River Medical Services

Doing business as Burlington Area Family Practice Center

  • Family Medicine Physician
  • West Burlington, IA
National Provider Identifier
1417025230
Registry record updated Oct 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GREAT RIVER MEDICAL SERVICES
Doing business as
Burlington Area Family Practice Center
Practice address
1201 W Agency Rd
West Burlington, IA 52655-1645
Phone
(319) 754-4242
Fax
(319) 754-4079
NPI assigned
Dec 1, 2006
Last updated
Oct 9, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2007

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

Authorized official

Name
Mr. Robert S Poetting
Title
Administrator
Phone
(319) 754-4242

Specialties & licenses 1

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

Addresses

Primary practice location

1201 W Agency Rd
West Burlington, IA 52655-1645

Mailing address

1201 W Agency Rd
West Burlington, IA 52655-1645
Phone (319) 754-4242

Other identifiers 1

IdentifierTypeStateIssuer
0198473MedicaidIA

Other names 1

  • Burlington Area Family Practice Center Doing business as

National Provider Directory

National Provider Directory

Locations

1201 W Agency Rd
West Burlington, IA 52655
Phone (319) 394-3991

1201 W Agency Rd
#1
West Burlington, IA 52655

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1417025230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 W AGENCY RD",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551645",
            "telephone_number": "319-754-4242",
            "fax_number": "319-754-4079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W AGENCY RD",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551645",
            "telephone_number": "319-754-4242",
            "fax_number": "319-754-4079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVER MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "POETTING",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "319-754-4242",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0198473",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Burlington Area Family Practice Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Burlington, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.