NPIMap

Individual provider Active NPI

Amy Marie Groen, D.O.

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Des Moines, IA
National Provider Identifier
1821078940
Registry record updated Sep 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
DO-03753 Issued in IA
Practice address
1200 Pleasant St
Des Moines, IA 50309-1406
Phone
(515) 241-6611
Fax
(515) 241-6635
NPI assigned
Jan 17, 2006
Last updated
Sep 30, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X DO-03753 IA Primary

Addresses

Primary practice location

1200 Pleasant St
Des Moines, IA 50309-1406

Mailing address

1200 Pleasant St
Blank Pediatric Emergency
Des Moines, IA 50309-1406
Phone (515) 241-6611

Other identifiers 3

IdentifierTypeStateIssuer
1821078940MedicaidMN
100264995-00MedicaidNE
1821078940MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110818000108 IA Practitioner - Pediatric Medicine 1456520915 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO-03753IAMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Iowa Hospital Corporation CurrentSince Sep 1, 2011 Accepting new patients
St Luke's Methodist Hospital Current Accepting new patients
Central Iowa Hospital Corporation Current Accepting new patients
Central Iowa Hospital Corporation Pediatric Emergency Medicine CurrentSince Sep 1, 2011 Accepting new patients
Central Iowa Hospital Corporation Past Accepting new patients
Central Iowa Hospital Corporation Past Accepting new patients

Locations

1200 Pleasant St
Des Moines, IA 50309
Phone (515) 241-5926

1200 Pleasant St
Ste S228
Des Moines, IA 50309

Interoperability endpoints

  • Direct secure messaging: agroen12676@direct.unitypoint.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475193600000",
    "number": "1821078940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 PLEASANT ST",
            "address_2": "BLANK PEDIATRIC EMERGENCY",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503091406",
            "telephone_number": "515-241-6611",
            "fax_number": "515-241-6635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 PLEASANT ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503091406",
            "telephone_number": "515-241-6611",
            "fax_number": "515-241-6635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROEN",
        "first_name": "AMY",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-17",
        "last_updated": "2016-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "IA",
            "license": "DO-03753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821078940",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100264995-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821078940",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.