Individual provider Active NPI

Carrie Janeczko, AUD

  • Audiologist
  • Clive, IA
National Provider Identifier
1619988581
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
0586 Issued in IA
Practice address
1601 NW 114TH St
Suite 230
Clive, IA 50325-7007
Phone
(515) 222-7761
Fax
(515) 222-7926
NPI assigned
Aug 10, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 0586 IA Primary

Addresses

Primary practice location

1601 NW 114TH St
Suite 230
Clive, IA 50325-7007

Mailing address

1055 6TH Ave
Suite 200
Des Moines, IA 50314-2607
Phone (515) 643-8672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00586IAMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinics, Inc. Past Accepting new patients
Mercy Clinics Inc Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619988581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 6TH AVE",
            "address_2": "SUITE 200",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142607",
            "telephone_number": "515-643-8672",
            "fax_number": "515-643-2784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 NW 114TH ST",
            "address_2": "SUITE 230",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503257007",
            "telephone_number": "515-222-7761",
            "fax_number": "515-222-7926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANECZKO",
        "first_name": "CARRIE",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IA",
            "license": "0586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.