Douglas J Jergenson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

22254 Issued in IA

Practice address

221 Main Ave
Clinton, IA 52732-2241

Phone

(563) 242-7522

Fax

(563) 242-7534

NPI assigned

Jun 10, 2005

Last updated

Oct 13, 2007By 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• River Cities Internal Medicine PC

  • Internal Medicine Physician
  • Clinton, IA
  • NPI 1922002591
  NPD (past) Authorized official

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192233600000",
    "number": "1689678344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 MAIN AVE",
            "city": "CLINTON",
            "state": "IA",
            "postal_code": "527322241",
            "telephone_number": "563-242-7522",
            "fax_number": "563-242-7534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 MAIN AVE",
            "city": "CLINTON",
            "state": "IA",
            "postal_code": "527322241",
            "telephone_number": "563-242-7522",
            "fax_number": "563-242-7534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERGENSON",
        "first_name": "DOUGLAS",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2007-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "22254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1193565",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J & S Kelly LLC (Kelly's Medical Equipment & Supply)
• Ashley Marie James, ARNP
• Cathy Jankowski, RN
• Lisa Marie Jansen, DNP, ARNP, FNP-C
• Gregory Allen Jasper, PNP
• Kelly J Jergenson, ARNP
• Stephen M Jewell, CRNA
• Benjamin Jobgen, PT
• Bridget R Johnson, D.C.
• Brooke Johnson, APN

• Internal Medicine Physician in Clinton, IA
• Providers in Clinton, IA by specialty
• Internal Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.