Organization Active NPI

Midwest Cardiovascular Research Foundation

  • Cardiovascular Disease Physician
  • Davenport, IA
National Provider Identifier
1891380432
Registry record updated Mar 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
MIDWEST CARDIOVASCULAR RESEARCH FOUNDATION
Practice address
630 E 4TH St Ste a
Davenport, IA 52801-1713
Phone
(563) 324-2828
NPI assigned
Mar 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2021

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

Authorized official

Name
Nicolas Shammas, MDNPI 1922087857
Title
Owner
Phone
(563) 320-0263

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

630 E 4TH St Ste a
Davenport, IA 52801-1713

Mailing address

PO Box 850
Moline, IL 61266-0850
Phone (309) 762-9711

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2110876Midwest Cardiovascular Research Foundation630 4TH Street, Suite a, Davenport, IA 52801Certificate of waiverMar 24, 2028

National Provider Directory

National Provider Directory

Locations

630 E 4th St
Ste A
Davenport, IA 52801
Phone (563) 324-2828

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614902400000",
    "number": "1891380432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612660850",
            "telephone_number": "309-762-9711",
            "fax_number": "309-764-0553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E 4TH ST STE A",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011713",
            "telephone_number": "563-324-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST CARDIOVASCULAR RESEARCH FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-05",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A",
        "authorized_official_last_name": "SHAMMAS",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-320-0263",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.