Donald T Van de Water, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

18576 Issued in NE

Practice address

800 Mercy Dr
Alegent Mercy Hospital Dept of Radiology
Council Bluffs, IA 51503-3128

Phone

(712) 328-5100

NPI assigned

Jun 20, 2006

Last updated

Mar 7, 2023By 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 2

Addresses

Other identifiers 11

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1710923800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4460",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68104",
            "telephone_number": "866-491-5807",
            "fax_number": "913-491-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MERCY DR",
            "address_2": "ALEGENT MERCY HOSPITAL DEPT OF RADIOLOGY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515033128",
            "telephone_number": "712-328-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DE WATER",
        "first_name": "DONALD",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NE",
            "license": "18576",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "21318",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3537282",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5537282",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IA CONTROLLED SUBSTANCE",
            "identifier": "AV9724039",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0537282",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS",
            "identifier": "24705",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4537282",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1310532",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC SHARE ALLIANCE",
            "identifier": "1600329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEBRASKA BCBS",
            "identifier": "03103",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA BCBS",
            "identifier": "19065",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC SHARE ALLIANCE",
            "identifier": "1600507",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Noah Urwiler, DPT
• Connie Utley
• Joyce Vacek, PAC
• Candice Stark Vallejo, LISW
• Desirae Vallier, LMHC
• Kelci Van Es, OTR
• Barbara J Van Gorp, MPT, DPT, CSCS
• Hope Ann Vanhorn
• Ven Healthcare Council Bluffs LLC
• Visinet of Iowa, Inc.

• Diagnostic Radiology Physician in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Diagnostic Radiology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.