Vincenzo Tine, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

125756 Issued in IA

Practice address

1300 37TH St Ste 1
West Des Moines, IA 50266-1900

Phone

(866) 227-9495

NPI assigned

Aug 13, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• LMMC LLC

  • Internal Medicine Physician
  • Omaha, NE
  • NPI 1033565098
  NPD
• LMMC Council Bluffs LLLP

  • General Practice Physician
  • Council Bluffs, IA
  • NPI 1861951568
  NPD (past)

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

{
    "created_epoch": "1723507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1811728504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12020 PACIFIC ST STE 100",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681543507",
            "telephone_number": "866-227-9495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 37TH ST STE 1",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661900",
            "telephone_number": "866-227-9495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TINE",
        "first_name": "VINCENZO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "125756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Lynn Reighard Tierney, M.D.
• Kenneth McCord Tierney, APRN
• Wendy Tillgren, LISW, LCSW
• Douglas M Timboe, MD
• Emma Timmerman
• Tiny Tongues Therapy, LLC
• Brent Michael Tisl
• TLC VC, LLC
• Todd W Christensen OD PLLC
• Dan Thomas Todd, DDS

• Physician Assistant in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.