NPIMap

Organization Active NPI

ENT Professional Services, PC

  • Specialist
  • Davenport, IA
National Provider Identifier
1457499758
Registry record updated Nov 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ENT PROFESSIONAL SERVICES, PC
Practice address
3385 Dexter CT
Suite 101
Davenport, IA 52807-3471
Phone
(563) 359-1646
Fax
(563) 344-6703
NPI assigned
Feb 1, 2007
Last updated
Nov 21, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2012

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

Authorized official

Name
Douglas W Dvorak, MDNPI 1346229762
Title
President
Phone
(563) 359-1646

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

3385 Dexter CT
Suite 101
Davenport, IA 52807-3471

Mailing address

3385 Dexter CT
Suite 101
Davenport, IA 52807-3471
Phone (563) 359-1646

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322001255 IA Part B Supplier - Clinic/Group Practice 8426949298 Receives reassigned benefits from 12 practitioners
Practice locations: Davenport, IA
O20180801001224 IL Part B Supplier - Clinic/Group Practice 8426949298 Receives reassigned benefits from 6 practitioners
Practice locations: Moline, IL

National Provider Directory

National Provider Directory

Locations

3385 Dexter Ct
Davenport, IA 52807
Phone (563) 344-6645

3385 Dexter Ct
Ste 101
Davenport, IA 52807
Phone (319) 359-1646

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.237

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353456000000",
    "number": "1457499758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3385 DEXTER CT",
            "address_2": "SUITE 101",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073471",
            "telephone_number": "563-359-1646",
            "fax_number": "563-344-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3385 DEXTER CT",
            "address_2": "SUITE 101",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073471",
            "telephone_number": "563-359-1646",
            "fax_number": "563-344-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT PROFESSIONAL SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2012-11-21",
        "status": "A",
        "authorized_official_last_name": "DVORAK",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "563-359-1646",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "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 21, 2012; 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.