Individual provider Active NPI

Mark S Puricelli, DO

  • Neurology Physician
  • Des Moines, IA
National Provider Identifier
1760596514
Registry record updated Mar 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
03224 Issued in IA
Practice address
1111 6TH Ave
East Tower Suite A100
Des Moines, IA 50314-2610
Phone
(515) 358-0011
Fax
(515) 358-0099
NPI assigned
Aug 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 03224 IA Primary

Addresses

Primary practice location

1111 6TH Ave
East Tower Suite A100
Des Moines, IA 50314-2610

Mailing address

PO Box 1475
Des Moines, IA 50306-1475
Phone (515) 358-0011

Other identifiers 1

IdentifierTypeStateIssuer
2187229MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20100322000081 IA Practitioner - Neurology 0749315398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinics IncGroup PAC ID 7911810882, 441 clinicians

Practice addresses (Care Compare)

1111 6TH Ave
Des Moines, IA 50314-2610

1111 6TH Ave E Tower
Des Moines, IA 50314-2610

300 W Hutchings St
Winterset, IA 50273-2109

330 Laurel St
Suite 1200
Des Moines, IA 50314-3044
Phone (515) 643-6290

800 E 1St St
Ankeny, IA 50021-2077

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinics, Inc. CurrentSince Jan 15, 2000 Accepting new patients
Mercy Clinics, Inc Neurology CurrentSince Jan 15, 2000 Accepting new patients
Mercy Clinics, Inc. Current Accepting new patients
Boone County Hospital Past Accepting new patients

Locations

330 Laurel St
Ste 1200
Des Moines, IA 50314
Phone (515) 643-5454

1111 6th Ave
Ste A100
Des Moines, IA 50314
Phone (515) 358-0011

300 W Hutchings St
Winterset, IA 50273
Phone (515) 223-4368

Interoperability endpoints

  • Direct secure messaging: mpuricelli3955805@direct.trinity-health.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/DDGADD
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268784000000",
    "number": "1760596514",
    "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": "503061475",
            "telephone_number": "515-358-0011",
            "fax_number": "515-358-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE",
            "address_2": "EAST TOWER SUITE A100",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142610",
            "telephone_number": "515-358-0011",
            "fax_number": "515-358-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURICELLI",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2010-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IA",
            "license": "03224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2187229",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.