NPIMap

Organization Active NPI

Ikc, LLC

Doing business as Iowa Ketamine Clinic

  • Clinic/Center
  • West Des Moines, IA
National Provider Identifier
1659904803
Registry record updated Oct 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
IKC, LLC
Doing business as
Iowa Ketamine Clinic
Practice address
1701 48TH St Ste 260
West Des Moines, IA 50266-6726
Phone
(515) 401-4774
Fax
(515) 254-3092
NPI assigned
Feb 17, 2020
Last updated
Oct 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2025

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

Authorized official

Name
Julie Otten
Title
Revenue Cycle Director
Phone
(515) 710-8720

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

1701 48TH St Ste 260
West Des Moines, IA 50266-6726

Mailing address

1701 48TH St Ste 260
West Des Moines, IA 50266-6726
Phone (515) 401-4774

Other practice location 1

1960 SW Magazine Rd
Ankeny, IA 50023-2978
Phone (515) 401-4774

Other names 1

  • Iowa Ketamine Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210212002431 IA Part B Supplier - Clinic/Group Practice 5294140851 Receives reassigned benefits from 22 practitioners
Practice locations: Ankeny, IA; West Des Moines, IA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2337 70th St
Urbandale, IA 50322
Phone (515) 401-4774

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759622400000",
    "number": "1659904803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 48TH ST STE 260",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502666726",
            "telephone_number": "515-401-4774",
            "fax_number": "515-254-3092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 48TH ST STE 260",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502666726",
            "telephone_number": "515-401-4774",
            "fax_number": "515-254-3092"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1960 SW Magazine Rd",
            "address_purpose": "LOCATION",
            "city": "Ankeny",
            "state": "IA",
            "postal_code": "500232978",
            "country_code": "US",
            "telephone_number": "515-401-4774",
            "fax_number": "515-254-3092",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IKC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-17",
        "last_updated": "2025-10-05",
        "certification_date": "2025-10-05",
        "status": "A",
        "authorized_official_last_name": "OTTEN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "515-710-8720"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iowa Ketamine Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Iowa Ketamine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2025; 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.