NPIMap

Organization Active NPI

Allen Memorial Hospital Corporation

Doing business as Allen Clinic Pharmacy

  • Clinic Pharmacy
  • Waterloo, IA
National Provider Identifier
1659461572
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
950 Issued in IA
Legal business name
ALLEN MEMORIAL HOSPITAL CORPORATION
Doing business as
Allen Clinic Pharmacy
Practice address
146 W Dale St
Suite 103
Waterloo, IA 50703-1901
Phone
(319) 235-3777
Fax
(319) 235-3134
NPI assigned
Oct 13, 2006
Last updated
Nov 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Authorized official

Name
Amy Bucknell, PHARMDNPI 1033436993
Title
Pic
Phone
(319) 235-3134

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 950 IA Primary

Addresses

Primary practice location

146 W Dale St
Suite 103
Waterloo, IA 50703-1901

Mailing address

146 W Dale St
Suite 103
Waterloo, IA 50703-1901
Phone (319) 235-3777

Other identifiers 2

IdentifierTypeStateIssuer
1618377MedicaidIA
2029507OtherPK

Other names 1

  • ALLEN CLINIC PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031211000480 IA Part B Supplier - Clinic/Group Practice 4284546045 Receives reassigned benefits from 301 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ottumwa, IA; Mason City, IA; Sumner, IA; Marshalltown, IA; Janesville, IA; Independence, IA; Waterloo, IA; Cedar Falls, IA…
O20200910003551 IA Part B Supplier - Mass Immunization (Roster Biller Only) 4284546045 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cedar Falls, IA; Waterloo, IA

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

146 W Dale St
Ste 103
Waterloo, IA 50703
Phone (319) 235-3176

Practitioners & affiliated clinicians

Practitioners 5

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": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1659461572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 W DALE ST",
            "address_2": "SUITE 103",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031901",
            "telephone_number": "319-235-3777",
            "fax_number": "319-235-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 W DALE ST",
            "address_2": "SUITE 103",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031901",
            "telephone_number": "319-235-3777",
            "fax_number": "319-235-3134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLEN MEMORIAL HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "BUCKNELL",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "319-235-3134",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "IA",
            "license": "950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1618377",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2029507",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALLEN CLINIC PHARMACY",
            "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 Nov 7, 2016; 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.