Packy A Huettman Jr., DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

03132 Issued in IA

Practice address

3200 West Kimberly Road
Suite 200
Davenport, IA 52806

Phone

(563) 355-9191

Fax

(563) 355-3419

NPI assigned

Jun 20, 2005

Last updated

Jun 29, 2021By the provider in NPPES

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

Other identifiers 6

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: packy.huettman@direct.genesishealth.com

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.

• Genesis Health System

  dba Genesis Convenient Care Bettendorf

  • Clinic/Center
  • Bettendorf, IA
  • NPI 1497772008
  Medicare reassignment
• Genesis Health System

  dba Genesis Health Group

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1477654945
  NPD
• Genesis Health System

  dba Genesis Medical Center Dewitt

  • Critical Access Hospital
  • De Witt, IA
  • NPI 1649368523
  NPD
• Genesis Health System

  dba Genesis Health Group

  • Family Medicine Physician
  • Bettendorf, IA
  • NPI 1225018211
  NPD (past)

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1831194307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 WEST KIMBERLY ROAD",
            "address_2": "SUITE 200",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52806",
            "telephone_number": "563-355-9191",
            "fax_number": "563-355-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 WEST KIMBERLY ROAD",
            "address_2": "SUITE 200",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52806",
            "telephone_number": "563-355-9191",
            "fax_number": "563-355-3419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUETTMAN",
        "first_name": "PACKY",
        "middle_name": "A",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "03132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BC/BS",
            "identifier": "30409",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4796890008",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA HEALTH SOLUTIONS",
            "identifier": "67701",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "066152",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH PLAN",
            "identifier": "IA01D2",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2167544",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "packy.huettman@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3200 W Kimberly Rd Ste 200",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528063059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert Alan Hudson, D.C.
• Elizabeth Huntington Mathis Huebl, D.C.
• Thomas Gerald Hueser, DDS
• Joshua Huetter
• Katie Huetter
• Elisa Gay Huff, PH.D.
• Taelor R Hufford
• Arielle Patrice Huggins, LMSW
• Mary T Hughes-Paulline, LISW
• Vicki R. Hughes, PA-C

• Family Medicine Physician in Davenport, IA
• Providers in Davenport, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.