Organization Active NPI

Trimark Physicians Group Inc

Family Medicine Physician
Fort Dodge, IA

National Provider Identifier

1891771978

Registry record updated Nov 26, 2010

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Fort Dodge, IA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name: TRIMARK PHYSICIANS GROUP INC
Practice address: 800 Kenyon Rd
Fort Dodge, IA 50501-5776
Phone: (515) 573-4141
NPI assigned: Dec 20, 2005
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Nov 26, 2010

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

Authorized official

Name: Michael J Dewerff
Title: Cfo
Phone: (515) 574-6603

Specialties & licenses 15

Specialty (taxonomy)	Code	Primary
Allergy & Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207K00000X
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207Q00000X	Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207R00000X
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207RN0300X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207RP1001X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	208000000X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	2084N0400X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	2085R0202X
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	2085R0204X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	208600000X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP	213E00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP	363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP	363L00000X

Addresses

Primary practice location

800 Kenyon Rd
Fort Dodge, IA 50501-5776

Mailing address

24 N 9TH St
Suite a
Fort Dodge, IA 50501-3909
Phone (515) 574-6890

Other identifiers 1

Identifier	Type	State	Issuer
0239764	Medicaid	IA

Other names 1

Trimark Physicians Group Doing business as

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290729600000",
    "number": "1891771978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 N 9TH ST",
            "address_2": "SUITE A",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505013909",
            "telephone_number": "515-574-6890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 KENYON RD",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015776",
            "telephone_number": "515-573-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIMARK PHYSICIANS GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2010-11-26",
        "status": "A",
        "authorized_official_last_name": "DEWERFF",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "515-574-6603"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0239764",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trimark Physicians Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Dodge, IA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.