Scott P Fackrell, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02977 Issued in IA

Practice address

6000 University Ave
Suite 101
West Des Moines, IA 50266-8203

Phone

(515) 241-2600

Fax

(515) 241-2032

NPI assigned

Dec 30, 2005

Last updated

Aug 30, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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

• Iowa Physicians Clinic Medical Foundation

  dba UnityPoint Clinic

  • General Practice Physician
  • West Des Moines, IA
  • NPI 1366425274

  Family Medicine

  Medicare reassignment NPD

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346284800000",
    "number": "1669459533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 UNIVERSITY AVE",
            "address_2": "SUITE 101",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502668203",
            "telephone_number": "515-241-2600",
            "fax_number": "515-241-2032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 UNIVERSITY AVE",
            "address_2": "SUITE 101",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502668203",
            "telephone_number": "515-241-2600",
            "fax_number": "515-241-2032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACKRELL",
        "first_name": "SCOTT",
        "middle_name": "P",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2012-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "02977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0130096",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1130096",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2130096",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eyecare Partners, P.C.
• Eyemart Express LLC
• Eyemart Express LLC
• Eyemart Express, LTD. (Vision 4 Less)
• Stephanie A Ezebuiro, MD
• Mouada Abdellatif Abdelaal Fadul, DMD
• Jonathan Andrew Fahler, DO
• Faith and Freedom Therapy LLC
• Family Directions of Iowa
• Family Orthodontics of Iowa, PLLC

• Family Medicine Physician in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.