NPIMap

Organization Active NPI

Evizzit of Iowa Psychiatry PC

  • Adult Mental Health Clinic/Center
  • West Des Moines, IA
National Provider Identifier
1679233183
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
EVIZZIT OF IOWA PSYCHIATRY PC
Practice address
1501 42ND St Ste 120
West Des Moines, IA 50266-1005
Phone
(855) 270-3625
NPI assigned
Dec 23, 2021
Last updated
Dec 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Authorized official

Name
Doug Wilson
Title
Assistant Vice President
Phone
(515) 979-5460

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

1501 42ND St Ste 120
West Des Moines, IA 50266-1005

Mailing address

1501 42ND St Ste 120
West Des Moines, IA 50266-1005
Phone (855) 270-3625

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL embracehealth.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191203001330 IA Part B Supplier - Clinic/Group Practice 2860825924 Receives reassigned benefits from 61 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Osage, IA; West Des Moines, IA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

1501 42nd St
Ste 120
West Des Moines, IA 50266

Practitioners & affiliated clinicians

Practitioners 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1640217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640217600000",
    "number": "1679233183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 42ND ST STE 120",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661005",
            "telephone_number": "855-270-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 42ND ST STE 120",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661005",
            "telephone_number": "855-270-3625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVIZZIT OF IOWA PSYCHIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-23",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "ASSISTANT VICE PRESIDENT",
        "authorized_official_telephone_number": "515-979-5460"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "embracehealth.com",
            "affiliation": "N",
            "endpointDescription": "patient portal within EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1501 42nd St Ste 120",
            "city": "West Des Moines",
            "state": "IA",
            "country_code": "US",
            "postal_code": "502661005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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 Dec 23, 2021; 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.