NPIMap

Individual provider Active NPI

Mark Alvin Kellerman, M.D.

  • Urology Physician
  • Clive, IA
National Provider Identifier
1891780995
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD-35053 Issued in IA
Practice address
12129 University Ave Ste 100
Clive, IA 50325-8298
Phone
(515) 400-3550
Fax
(515) 400-3551
NPI assigned
Sep 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD-35053 IA Primary

Addresses

Primary practice location

12129 University Ave Ste 100
Clive, IA 50325-8298

Mailing address

12129 University Ave Ste 100
Clive, IA 50325-8298
Phone (515) 400-3550

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
I20070731000134 IA Practitioner - Urology 7517068851 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Iowa, RJ & L Carver College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urology Center of Iowa PLLC 32 clinicians
Broadlawns Medical Center 302 clinicians
Guthrie County Hospital 16 clinicians

Practice addresses (Care Compare)

111 NW 9TH St
Ankeny, IA 50023-1754
Phone (515) 400-3550

12129 University Ave
Clive, IA 50325-8287
Phone (515) 400-3550

13375 University Ave
Suite 100
Clive, IA 50325-8262
Phone (515) 400-3550

1660 60TH St
West Des Moines, IA 50266-7700
Phone (515) 343-1000

1755 59TH PL
West Des Moines, IA 50266-7737
Phone (515) 358-8000

1801 Hickman Rd
Des Moines, IA 50314-1548
Phone (515) 282-2200

700 E Uinversity Ave
Des Moines, IA 50316-2302
Phone (515) 263-5612

710 N 12TH St
Guthrie Center, IA 50115-1549
Phone (641) 332-2201

Hospital & facility affiliations

  • Mercyone Des Moines Medical Center Hospital, Des Moines, IA, CCN 160083
  • Guthrie County Hospital Hospital, Guthrie Center, IA, CCN 161314
  • Unitypoint Health - Des Moines Iowa Methodist Medi Hospital, Des Moines, IA, CCN 160082
  • Broadlawns Medical Center Hospital, Des Moines, IA, CCN 160101
  • Wayne County Hospital Hospital, Corydon, IA, CCN 161358

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection51
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Broadlawns Medical Center CurrentSince Jan 15, 2019 Accepting new patients
Urology Center of Iowa PLLC Urology CurrentSince Nov 1, 2018 Accepting new patients
Guthrie County Hospital CurrentSince Aug 3, 2023 Accepting new patients
Broadlawns Medical Center CurrentSince Jan 15, 2019 Accepting new patients
Pella Regional Health Center CurrentSince May 11, 2022 Accepting new patients
Cass County Memorial Hospital Current Accepting new patients
Pella Regional Health Center CurrentSince May 11, 2022 Accepting new patients
Pella Regional Health Center Current Accepting new patients
Cass County Memorial Hospital CurrentSince Jul 1, 2025 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Cass County Memorial Hospital CurrentSince Jul 1, 2025 Accepting new patients
Surgery Centers of Iowa LLC Current Accepting new patients
Guthrie County Hospital CurrentSince Aug 3, 2023 Accepting new patients
Boone County Hospital Past Accepting new patients
Urology Partners of North Texas, PLLC Urology PastSince Nov 3, 2024 Accepting new patients

Locations

111 NW 9th St
Ankeny, IA 50023
Phone (515) 964-7355

1501 E 10th St
Atlantic, IA 50022
Phone (712) 243-2850

13375 University Ave
Ste 100
Clive, IA 50325
Phone (515) 327-1555

12129 University Ave
Ste 200
Clive, IA 50325

12129 University Ave
Ste 100
Clive, IA 50325
Phone (515) 400-3550

1801 Hickman Rd
Des Moines, IA 50314
Phone (515) 282-2200

1801 Hickman Rd
Bldg First
Des Moines, IA 50314

710 N 12th St
Guthrie Ctr, IA 50115
Phone (641) 332-2201

405 Monroe St
Pella, IA 50219
Phone (641) 621-2200

Interoperability endpoints

  • Direct secure messaging: mkellerman12532@direct.unitypoint.org
  • Direct secure messaging: markkellerman@uciwa.allscriptsdirect.net
  • Direct secure messaging: mkellerman160137@uihcdirect.org
  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10390883
  • FHIR API: https://fhir-myrecord.cerner.com/r4/18f5d65c-83f0-435a-868c-70ce5a6de90a/
  • Direct secure messaging: kellerman.mark@cynchealthdsm.org

Organizations & group practices 19

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 19

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1891780995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12129 UNIVERSITY AVE STE 100",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258298",
            "telephone_number": "515-400-3550",
            "fax_number": "515-400-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12129 UNIVERSITY AVE STE 100",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258298",
            "telephone_number": "515-400-3550",
            "fax_number": "515-400-3551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLERMAN",
        "first_name": "MARK",
        "middle_name": "ALVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IA",
            "license": "MD-35053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

Verify at the official NPI Registry.