Newton Clinic PC
Organization Active NPI Family Medicine Physician · Newton, IA
NPI 1730115213 · NPPES record last updated Jun 13, 2013
Key facts
- NPI
- 1730115213
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- NEWTON CLINIC PC
- Practice address
- 300 N 4TH Ave E
Suite 200
Newton, IA 50208-3155 - Phone
- (641) 792-2112
- Fax
- (641) 792-8484
- NPI assigned
- Jun 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Mark Thayer
- Title
- Clinic Adminstrator
- Phone
- (641) 792-2112
Member organizations 1
Practitioners 27
-
Zachary John Bliek, DPM
-
Tze Y. Chan, DO
-
Patrick J Cogley, MD
-
Dennis Paul Dornbier, D.O.
-
Tara Gravenstine, DO
-
Steven C. Hill, MD
-
Jodi F Holloway, ARNP
-
Kenzie Leanne Huyser, FNP-C
-
Min S. Pak, MD
-
Luke Robert Perrin, M.D.
-
Sydney Rice, DO
-
Laurie A. Siddall, FNP
-
Sarah Sue Neal, ARNP
-
Paul E. Ruggle, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040325000962 | IA | Part B Supplier - Clinic/Group Practice | 6608768676 |
Receives reassigned benefits from 24 practitioners Practice locations: Newton, IA |
| O20100930052630 | IA | DME Supplier - Physician - Family Practice | 6608768676 | Practice locations: Newton, IA |
National Provider Directory
Locations
1501 1st Ave E
Newton, IA 50208
Phone (641) 792-1000
300 N 4th Ave E
Newton, IA 50208
Phone (515) 644-3400
Interoperability endpoints
- https://api.platform.athenahealth.com/31005/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Podiatrist |
213E00000X |
Addresses
Primary practice location
300 N 4TH Ave E
Suite 200
Newton, IA 50208-3155
Mailing address
300 N 4TH Ave E
Suite 200
Newton, IA 50208-3155
Phone (641) 792-2112
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0282186 | Medicaid | IA |
Other providers in Newton, IA
- Nelson Manor Inc
- Angela L. Nelson
- New Care Clinics LLC
- Newton C.S.D.
- Newton Care LLC
- Newton Eye Clinic, P.C.
- Newton Family Chiropractic PLLC
- Newton Family Eye Care, P.C.
- Newton Health Care Center LLC
- Newton Optometric Center P C
All providers in Newton, IA · Family Medicine Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.