Active NPI
Angela Elliott, D.O.
- Family Medicine Physician
- Muscatine, IA
National Provider Identifier
1629490123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO-04528
- Practice address
- 1518 Mulberry Ave
Muscatine, IA 52761-3433 - Phone
- (563) 264-9508
- Fax
- (563) 264-0166
- NPI assigned
- Jan 17, 2014
- Last updated
- Jan 21, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DO-04528 | IA | Primary |
Addresses
Primary practice location
1518 Mulberry Ave
Muscatine, IA 52761-3433
Mailing address
1518 Mulberry Ave
Muscatine, IA 52761-3433
Phone (563) 264-9508
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982831426 | Medicaid | IA |
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO-04528 | IA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trinity Medical Center | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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": "1389916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390262400000",
"number": "1629490123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1518 MULBERRY AVE",
"city": "MUSCATINE",
"state": "IA",
"postal_code": "527613433",
"telephone_number": "563-264-9508",
"fax_number": "563-264-0166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1518 MULBERRY AVE",
"city": "MUSCATINE",
"state": "IA",
"postal_code": "527613433",
"telephone_number": "563-264-9508",
"fax_number": "563-264-0166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "ANGELA",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-17",
"last_updated": "2014-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "DO-04528",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1982831426",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Muscatine, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.