NPIMap

Organization Active NPI

Covenant Medical Center Inc

Doing business as MercyOne Waterloo Medical Center

  • Clinical Neuropsychologist
  • Waterloo, IA
National Provider Identifier
1639110653
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
COVENANT MEDICAL CENTER INC
Doing business as
MercyOne Waterloo Medical Center
Practice address
3421 W 9TH St
Waterloo, IA 50702-5401
Phone
(319) 272-7600
Fax
(319) 272-7597
NPI assigned
Jun 9, 2006
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X Primary

Addresses

Primary practice location

3421 W 9TH St
Waterloo, IA 50702-5401

Mailing address

3421 W 9TH St
Waterloo, IA 50702-5401
Phone (319) 272-7600

Other names 1

  • MercyOne Waterloo Medical Center 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
This NPI is an additional NPI on the enrollment
Practice locations: Tripoli, IA; Cedar Falls, IA; Waterloo, IA; Waverly, IA; Parkersburg, IA; Evansdale, IA; Fairbank, IA; Jesup, IA…

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
Tax ID family
Lee O Fagre MD15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1639110653",
    "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": "319-272-7600",
            "fax_number": "319-272-7597"
        },
        {
            "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": "319-272-7600",
            "fax_number": "319-272-7597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "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": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MercyOne Waterloo Medical Center",
            "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 Oct 10, 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.