Mindy Baccam Southammavong, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

078982 Issued in IA

Practice address

405 Monroe St
Pella, IA 50219-1189

Phone

(641) 621-2200

Fax

(641) 621-2335

NPI assigned

Aug 20, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mindy Shine Baccam Other name

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iowa Physicians Clinic Medical FoundationGroup PAC ID 8729992318, 1,254 clinicians

Pella Regional Health CenterGroup PAC ID 9931005873, 96 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pella Regional Health Center Hospital, Pella, IA, CCN 161367

Merit-based Incentive Payment System (MIPS)

Final score

91.84 of 100Reported as group

Quality

91.13

Promoting interoperability

100

Improvement activities

40

Cost

81.67

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: msouthammavong1119678@direct.unitypoint.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Iowa Physicians Clinic Medical Foundation

  • General Practice Physician
  • West Des Moines, IA
  • NPI 1366425274
  Medicare reassignment Care Compare group NPD
• Pella Regional Health Center

  • Multi-Specialty Clinic/Center
  • Pella, IA
  • NPI 1053369405
  Medicare reassignment Care Compare group NPD
• Pella Regional Health Center

  • Critical Access Hospital
  • Pella, IA
  • NPI 1578520888
  Medicare reassignment
• Iowa Physicians Clinic Medical Foundation

  • Rural Health Clinic/Center
  • Kingsley, IA
  • NPI 1659263523
  NPD
• Pella Regional Health Center

  • Community/Retail Pharmacy
  • Prairie City, IA
  • NPI 1033787445
  NPD
• Pella Regional Health Center

  • Rehabilitation Clinic/Center
  • Pella, IA
  • NPI 1548923253
  NPD
• St Luke'S Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD
• Annie M. Kontos, P.C.

  • Family Medicine Physician
  • Waterloo, IA
  • NPI 1528248861
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pella Regional Health Center

  • Critical Access Hospital
  • Pella, IA
  • NPI 1578520888
  Care Compare affiliation

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493596800000",
    "number": "1528434859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 MONROE ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191189",
            "telephone_number": "641-621-2200",
            "fax_number": "641-621-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 MONROE ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191189",
            "telephone_number": "641-621-2200",
            "fax_number": "641-621-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHAMMAVONG",
        "first_name": "MINDY",
        "middle_name": "BACCAM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-20",
        "last_updated": "2017-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "078982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1528434859",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA LICENSE",
            "identifier": "078982",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MINDY",
            "last_name": "BACCAM",
            "middle_name": "SHINE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Medical Physician Assistant in Pella, IA
• Providers in Pella, IA by specialty
• Medical Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.