NPIMap

Organization Active NPI

Mercy Medical Center-Centerville

  • Family Medicine Physician
  • Centerville, IA
National Provider Identifier
1679700173
Registry record updated Jun 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MERCY MEDICAL CENTER-CENTERVILLE
Practice address
19876 St. Joseph'S Drive
Centerville, IA 52544
Phone
(641) 856-8684
NPI assigned
Jun 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2010

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

Authorized official

Name
Pam Young
Title
Business Office Manager
Phone
(641) 437-3413

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

19876 St. Joseph'S Drive
Centerville, IA 52544

Mailing address

19876 St. Joseph'S Drive
Centerville, IA 52544
Phone (641) 856-8684

Other identifiers 1

IdentifierTypeStateIssuer
IB1441OtherPTAN

Other names 1

  • Centerville Medical Clinic-Mercy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000762 IA Part B Supplier - Clinic/Group Practice 9739077652 Receives reassigned benefits from 58 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centerville, IA; Ottumwa, IA

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

411 Laurel St
Ste A250
Des Moines, IA 50314
Phone (515) 235-5000

NPI Registry JSON

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

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276041600000",
    "number": "1679700173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19876 ST. JOSEPH'S DRIVE",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "52544",
            "telephone_number": "641-856-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19876 ST. JOSEPH'S DRIVE",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "52544",
            "telephone_number": "641-856-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEDICAL CENTER-CENTERVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-11",
        "last_updated": "2010-06-09",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "641-437-3413"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "IB1441",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centerville Medical Clinic-Mercy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2010; 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.