Rooted Pediatric Healthcare LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ROOTED PEDIATRIC HEALTHCARE LLC

Practice address

105 E Butler St
Manchester, IA 52057-1606

Phone

(319) 480-2540

NPI assigned

Mar 14, 2024

Last updated

Apr 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brooke Ann Mactaggart, CPNP-PCNPI 1194507954

Title

Pediatric Nurse Practitioner

Phone

(319) 480-2540

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Practitioners 1

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.

• Brooke Ann Mactaggart, CPNP-PC

  • Pediatric Nurse Practitioner
  • Manchester, IA
  • NPI 1194507954

  Pediatrics

  NPD Authorized official

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

{
    "created_epoch": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1548029390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 ANDERSON ST",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "520571401",
            "telephone_number": "319-480-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E BUTLER ST",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "520571606",
            "telephone_number": "319-480-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTED PEDIATRIC HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "MACTAGGART",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PEDIATRIC NURSE PRACTITIONER",
        "authorized_official_telephone_number": "319-480-2540",
        "authorized_official_credential": "CPNP-PC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Rose Reece, ARNP
• Reetz Chiropractic Clinic
• Reetz Chiropractic Clinic, PC
• Mark A Reetz, D.C.
• Kelli Lynn Riniker, RPH
• Carly Roskop
• Robert Allen Sack, RPH
• Victor Salas, M.D.
• Katie Salle, PHARMD
• Nicole M Salow, M.D.

• Primary Care Clinic/Center in Manchester, IA
• Providers in Manchester, IA by specialty
• Primary Care Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.