Individual provider Active NPI

Grace Anne Kulischak, DO

  • Internal Medicine Physician
  • Des Moines, IA
National Provider Identifier
1689569113
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R-13474 Issued in IA
Practice address
1415 Woodland Ave Ste 140
Des Moines, IA 50309-3203
Phone
(515) 241-6636
NPI assigned
Jun 12, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X R-13474 IA Primary

Addresses

Primary practice location

1415 Woodland Ave Ste 140
Des Moines, IA 50309-3203

Mailing address

1415 Woodland Ave Ste 140
Des Moines, IA 50309-3203
Phone (515) 241-6636

Other practice location 1

1801 Hickman Rd
Des Moines, IA 50314-1548
Phone (515) 282-2200

Other practice location 2

3600 30th St
Des Moines, IA 50310-5753
Phone (515) 699-5999

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250715000971 IA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 3274048640

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
R-13474IAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation Internal Medicine PastSince Jun 15, 2025 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: gkulischak1080942@direct.unitypoint.org

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1749686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749686400000",
    "number": "1689569113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 WOODLAND AVE STE 140",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503093203",
            "telephone_number": "515-241-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 WOODLAND AVE STE 140",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503093203",
            "telephone_number": "515-241-6636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1801 Hickman Rd",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503141548",
            "country_code": "US",
            "telephone_number": "515-282-2200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3600 30th St",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503105753",
            "country_code": "US",
            "telephone_number": "515-699-5999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KULISCHAK",
        "first_name": "GRACE",
        "middle_name": "ANNE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-06-12",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "R-13474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.