Individual provider Active NPI

Bery J Engebretsen, M.D.

  • Family Medicine Physician
  • Des Moines, IA
National Provider Identifier
1609924208
Registry record updated May 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17792 Issued in IA
Practice address
2353 SE 14TH St
Des Moines, IA 50320-1109
Phone
(515) 248-1400
Fax
(515) 248-1440
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17792 IA Primary

Addresses

Primary practice location

2353 SE 14TH St
Des Moines, IA 50320-1109

Mailing address

3509 E 29TH St
Des Moines, IA 50317-4253
Phone (515) 248-1600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17792IAMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401321600000",
    "number": "1609924208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3509 E 29TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503174253",
            "telephone_number": "515-248-1600",
            "fax_number": "515-248-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2353 SE 14TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503201109",
            "telephone_number": "515-248-1400",
            "fax_number": "515-248-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGEBRETSEN",
        "first_name": "BERY",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2014-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "17792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.