NPIMap

Organization Active NPI

Covenant Medical Center Inc

Doing business as MercyOne Medical Group Northeast Iowa

  • Family Medicine Physician
  • Waterloo, IA
National Provider Identifier
1548288160
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1878 Issued in IA
Legal business name
COVENANT MEDICAL CENTER INC
Doing business as
MercyOne Medical Group Northeast Iowa
Practice address
3421 W 9TH St
Waterloo, IA 50702-5401
Phone
(319) 272-7303
Fax
(319) 272-7318
NPI assigned
Jul 18, 2006
Last updated
Dec 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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

Authorized official

Name
Timothy Huber
Title
Controller
Phone
(319) 272-7607

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Psychologist 103T00000X
Social Worker 104100000X
Family Medicine Physician 207Q00000X 1878 IA Primary
Podiatrist 213E00000X
Audiologist 231H00000X
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Certified Registered Nurse Anesthetist 367500000X

Addresses

Primary practice location

3421 W 9TH St
Waterloo, IA 50702-5401

Mailing address

3421 W 9TH St
Waterloo, IA 50702-5401
Phone (319) 272-7304

Other identifiers 1

IdentifierTypeStateIssuer
0190686MedicaidIA

Other names 1

  • MercyOne Medical Group Northeast Iowa Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000534 IA Part B Supplier - Clinic/Group Practice 0244148732 Receives reassigned benefits from 278 practitioners
3 other NPIs on this enrollment
Practice locations: Tripoli, IA; Cedar Falls, IA; Waterloo, IA; Waverly, IA; Parkersburg, IA; Evansdale, IA; Fairbank, IA; Jesup, IA…

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

226 Bluebell Rd
Ste Cc
Cedar Falls, IA 50613
Phone (319) 575-5600

515 College St
Ste 2800
Cedar Falls, IA 50613
Phone (319) 268-3990

501 Clark St
Dysart, IA 52224
Phone (319) 476-4000

2055 Kimball Ave
Ste 101
Waterloo, IA 50702
Phone (319) 272-2112

2710 Saint Francis Dr
Ste 510A
Waterloo, IA 50702

2750 Saint Francis Dr
Waterloo, IA 50702
Phone (319) 272-8922

3421 W 9th St
Ste G4500
Waterloo, IA 50702
Phone (319) 233-8865

Practitioners & affiliated clinicians

Practitioners 293

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 293

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1548288160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 W 9TH ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025401",
            "telephone_number": "319-272-7304",
            "fax_number": "319-272-7318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3421 W 9TH ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025401",
            "telephone_number": "319-272-7303",
            "fax_number": "319-272-7318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "HUBER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "319-272-7607"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "1878",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0190686",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MercyOne Medical Group Northeast Iowa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; 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.