Active NPI
Ajak Mayen, MD
- Family Medicine Physician
- Waterloo, IA
National Provider Identifier
1841974938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R-12883
- Practice address
- 2055 Kimball Ave Ste 101
Waterloo, IA 50702-5047 - Phone
- (319) 272-2112
- NPI assigned
- Jun 9, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R-12883 | IA | Primary |
Addresses
Primary practice location
2055 Kimball Ave Ste 101
Waterloo, IA 50702-5047
Mailing address
1710 SE Heritage Dr
Waukee, IA 50263-9689
Phone (515) 639-1933
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230804000324 | IA | Order and Referring Only - Family Practice | 0042671257 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-12883 | IA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686268800000",
"number": "1841974938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1710 SE HERITAGE DR",
"city": "WAUKEE",
"state": "IA",
"postal_code": "502639689",
"telephone_number": "515-639-1933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2055 KIMBALL AVE STE 101",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507025047",
"telephone_number": "319-272-2112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYEN",
"first_name": "AJAK",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-09",
"last_updated": "2023-06-09",
"certification_date": "2023-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "R-12883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; 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.