NPIMap

Organization Active NPI

Pathology Associates of Central Iowa, PLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Des Moines, IA
National Provider Identifier
1639107295
Registry record updated Feb 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
NA Issued in IA
Legal business name
PATHOLOGY ASSOCIATES OF CENTRAL IOWA, PLC
Practice address
1111 6TH Ave
Mercy Medical Center - Pathology
Des Moines, IA 50314-2613
Phone
(515) 247-3115
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2024

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

Authorized official

Name
Sue Miranda
Title
Office Manager
Phone
(515) 247-4467

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X NA IA Primary

Addresses

Primary practice location

1111 6TH Ave
Mercy Medical Center - Pathology
Des Moines, IA 50314-2613

Mailing address

1111 6TH Ave
Des Moines, IA 50314-2613
Phone (515) 247-4467

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050516000234 IA Part B Supplier - Clinic/Group Practice 6305887811 Receives reassigned benefits from 9 practitioners
Practice locations: Des Moines, IA

National Provider Directory

National Provider Directory

Locations

2555 106th St
Urbandale, IA 50322

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707004800000",
    "number": "1639107295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142613",
            "telephone_number": "515-247-4467",
            "fax_number": "515-643-8911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE",
            "address_2": "MERCY MEDICAL CENTER - PATHOLOGY",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142613",
            "telephone_number": "515-247-3115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY ASSOCIATES OF CENTRAL IOWA, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2024-02-04",
        "certification_date": "2024-02-04",
        "status": "A",
        "authorized_official_last_name": "MIRANDA",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "515-247-4467"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IA",
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2024; 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.