NPIMap

Individual provider Active NPI

Patrick J Pucelik, ARNP

  • Nurse Practitioner
  • Whiting, IA
National Provider Identifier
1649247362
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A-106028 Issued in IA
Practice address
153 Blair St
Whiting, IA 51063-1007
Phone
(712) 455-2431
Fax
(712) 455-2698
NPI assigned
Mar 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X A-106028 IA Primary
General Practice Physician 208D00000X A-106028 IA

Addresses

Primary practice location

153 Blair St
Whiting, IA 51063-1007

Mailing address

153 Blair St
Whiting, IA 51063-1007
Phone (712) 455-2431

Other identifiers 1

IdentifierTypeStateIssuer
500018631OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100816001087 IA Practitioner - Nurse Practitioner 6406917236 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shelby County Chris a Myrtue Memorial Hospital 49 clinicians

Practice addresses (Care Compare)

1213 Garfield Ave
Harlan, IA 51537-2057
Phone (712) 755-5161

Hospital & facility affiliations

  • Myrtue Medical Center Hospital, Harlan, IA, CCN 161374
  • Methodist Jennie Edmundson Hospital, Council Bluffs, IA, CCN 160047
  • Elm Crest Retirement Community Nursing home, Harlan, IA, CCN 165372

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A-106028IAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shelby County Chris a. Myrtue Memorial Hospital Nurse Practitioner CurrentSince Oct 1, 2011 Accepting new patients
Shelby County Chris a Myrtue Memorial Hospital Current Accepting new patients
J. L. Garred, Sr., M.D.P.C. Nurse Practitioner Current Accepting new patients
Alegent Health Quick Care LLC Nurse Practitioner Past Accepting new patients
Alegent Creighton Clinic Past Accepting new patients
Alegent Creighton Clinic Past Accepting new patients

Locations

1220 Chatburn Ave
Harlan, IA 51537
Phone (712) 755-5056

1213 Garfield Ave
Harlan, IA 51537
Phone (712) 755-4316

153 Blair St
#289
Whiting, IA 51063

153 Blair St
Whiting, IA 51063
Phone (712) 455-2431

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pleasant View Care CenterWhiting, IA, CCN 165296 Skilled nursing facility Corporate Director Oct 28, 2008

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 16

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

View all 16

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1649247362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 BLAIR ST",
            "city": "WHITING",
            "state": "IA",
            "postal_code": "510631007",
            "telephone_number": "712-455-2431",
            "fax_number": "712-455-2698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 BLAIR ST",
            "city": "WHITING",
            "state": "IA",
            "postal_code": "510631007",
            "telephone_number": "712-455-2431",
            "fax_number": "712-455-2698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCELIK",
        "first_name": "PATRICK",
        "middle_name": "J",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A-106028",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IA",
            "license": "A-106028",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "500018631",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiting, IA

Sources for this page

Verify at the official NPI Registry.