Organization Active NPI

Obstetrics and Gynecology Specialists PC

  • Obstetrics & Gynecology Physician
  • Davenport, IA
National Provider Identifier
1427003011
Registry record updated Nov 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
OBSTETRICS AND GYNECOLOGY SPECIALISTS PC
Practice address
5350 Eastern Avenue
Davenport, IA 52807
Phone
(563) 355-1853
Fax
(563) 355-0327
NPI assigned
May 23, 2006
Last updated
Nov 15, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2017

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

Authorized official

Name
Jenie Marie Graham
Title
Credentialing
Phone
(563) 355-1853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X Primary

Addresses

Primary practice location

5350 Eastern Avenue
Davenport, IA 52807

Mailing address

5350 Eastern Avenue
Davenport, IA 52807
Phone (563) 355-1853

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040312001330 IA Part B Supplier - Clinic/Group Practice 8426947813 Receives reassigned benefits from 8 practitioners
Practice locations: Clinton, IA; Davenport, IA; Maquoketa, IA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0388094Obstetrics & Gynecology Specialists, PC5350 Eastern Avenue, Davenport, IA 52807Provider-performed microscopyAug 31, 2026
16D2321716Obstetrics and Gynecology Specialists PC5350 Eastern Ave Ste 100, Davenport, IA 52807ComplianceOct 7, 2027

National Provider Directory

National Provider Directory

Locations

4321 53rd Ave
Bettendorf, IA 52722
Phone (563) 421-5300

5350 Eastern Ave
Davenport, IA 52807
Phone (563) 355-1853

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1036

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510704000000",
    "number": "1427003011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5350 EASTERN AVENUE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52807",
            "telephone_number": "563-355-1853",
            "fax_number": "563-355-0327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5350 EASTERN AVENUE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52807",
            "telephone_number": "563-355-1853",
            "fax_number": "563-355-0327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSTETRICS AND GYNECOLOGY SPECIALISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2017-11-15",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "JENIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "563-355-1853"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.