Proteus Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

PROTEUS INC.

Practice address

1221 Center St Ste 16
Des Moines, IA 50309-1000

Phone

(515) 271-5303

Fax

(515) 271-5309

NPI assigned

Jul 9, 2009

Organization subpart

No

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

Authorized official

Name

Jesus Soto

Title

Ceo

Phone

(515) 348-6646

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 161855

Legal name

PROTEUS INC.

Doing business as

PROTEUS INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 2, 2010

Last certification

Jun 2, 2010

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

107 N 7TH St
Fort Dodge, IA 50501-3830

Federally qualified health center certification: CCN 161005

Legal name

PROTEUS INC.

Doing business as

PROTEUS INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 1, 2022

Last certification

Dec 1, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

1221 Center St
Ste 16
Des Moines, IA 50309-1014

Federally qualified health center certification: CCN 161875

Legal name

PROTEUS INC DES MOINE SITE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 15, 2018

Last certification

May 15, 2018

Ownership / control type

For profit – partnership

Facility address

1221 Center St Ste 16
Des Moines, IA 50309

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CGDADA

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Hijinio G. Carreon, D.O.

  • Emergency Medicine Physician
  • Des Moines, IA
  • NPI 1033122072

  Corporate Director

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Courtney Lowy, PA-C

  • Medical Physician Assistant
  • Des Moines, IA
  • NPI 1295282325
  NPD (past)
• Angelica Rodriguez, ARNP

  • Family Nurse Practitioner
  • Des Moines, IA
  • NPI 1962206052
  NPD (past)
• Emily Sinnwell, ARNP

  • Family Nurse Practitioner
  • Des Moines, IA
  • NPI 1932452901
  NPD (past)

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525219200000",
    "number": "1497984579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 CENTER ST STE 16",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503091014",
            "telephone_number": "515-271-5306",
            "fax_number": "515-271-5309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 CENTER ST STE 16",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503091000",
            "telephone_number": "515-271-5303",
            "fax_number": "515-271-5309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTEUS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-09",
        "last_updated": "2018-05-02",
        "status": "A",
        "authorized_official_last_name": "SOTO",
        "authorized_official_first_name": "JESUS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-348-6646"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Migrant Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Joan Pruisner
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• Sheryl R Puderbaugh, CM, ARNP

• Federally Qualified Health Center (FQHC) in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Federally Qualified Health Center (FQHC) in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.