Individual provider Active NPI

Brady Goodwin, DO

  • Psychiatry Physician
  • Des Moines, IA
National Provider Identifier
1730839002
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
R-12606 Issued in IA
Practice address
1111 6TH Ave
Des Moines, IA 50314-2613
Phone
(515) 643-2682
Fax
(515) 643-5802
NPI assigned
Mar 28, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X DO-06673 IA
Student in an Organized Health Care Education/Training Program 390200000X IA
Psychiatry Physician 2084P0800X R-12606 IA Primary

Addresses

Primary practice location

1111 6TH Ave
Des Moines, IA 50314-2613

Mailing address

PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 643-2682

Other practice location 1

700 E University Ave
Des Moines, IA 50316-2302
Phone (971) 246-2061

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20260403000448 NC Order and Referring Only - PsychiatryPractitioner - Psychiatry 3173902699

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO-06673IAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Physicians Clinic Medical Foundation CurrentSince Jul 19, 2024 Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

1111 6th Ave
Des Moines, IA 50314
Phone (515) 247-3121

700 E University Ave
Des Moines, IA 50316
Phone (515) 263-5120

Organizations & group practices 1

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": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1730839002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-643-2682",
            "fax_number": "515-643-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142613",
            "telephone_number": "515-643-2682",
            "fax_number": "515-643-5802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 E University Ave",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503162302",
            "country_code": "US",
            "telephone_number": "971-246-2061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "BRADY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-28",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "DO-06673",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "R-12606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.