Douglas Jae Miedema, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2364 Issued in IA

Practice address

600 9TH Ave N
Sibley, IA 51249-1012

Phone

(712) 754-3658

Fax

(712) 754-2634

NPI assigned

Aug 15, 2005

Last updated

Jul 1, 2013By 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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Sanford Health Network

  dba Sanford Clinic Tracy

  • Family Medicine Physician
  • Tracy, MN
  • NPI 1699869875
  NPD

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372636800000",
    "number": "1720080237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 9TH AVE N",
            "address_2": "P.O. BOX 277",
            "city": "SIBLEY",
            "state": "IA",
            "postal_code": "512491012",
            "telephone_number": "712-754-3658",
            "fax_number": "712-754-2634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 9TH AVE N",
            "city": "SIBLEY",
            "state": "IA",
            "postal_code": "512491012",
            "telephone_number": "712-754-3658",
            "fax_number": "712-754-2634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIEDEMA",
        "first_name": "DOUGLAS",
        "middle_name": "JAE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2013-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "2364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "537072800",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2049429",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME HEALTH MEDICARE",
            "identifier": "167177",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "115478",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ann Konda
• Gregory Jay Kosters, D.O.
• Jill N Kunzman, O.D.
• Jill N Leusink, PHARMD
• Kelsey Lonneman, PHARM D.
• Zachary David Ney, OD
• NW Ia Vision PLLC (Sibley Eyecare)
• Osceola Community Health Services
• Osceola Community Hospital Inc (Osceola Regional Health Center)
• Osceola Community Hospital Inc (ORHC Specialty Clinic)

• Family Medicine Physician in Sibley, IA
• Providers in Sibley, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; 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.