Active NPI
Robert Adam Fornoff, M.D.
- Pediatrics Physician
- Des Moines, IA
National Provider Identifier
1902877707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35011
- Practice address
- 2301 Beaver Ave
Des Moines, IA 50310-3903 - Phone
- (515) 255-3181
- Fax
- (515) 255-9392
- NPI assigned
- Jan 30, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35011 | IA | Primary |
Addresses
Primary practice location
2301 Beaver Ave
Des Moines, IA 50310-3903
Mailing address
2301 Beaver Ave
Des Moines, IA 50310-3903
Phone (515) 255-3181
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20764 | Other | IA | BCBS-EAST |
| 20794 | Other | IA | BCBS-WEST |
| 0431916 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35011 | IA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boone County Hospital | Past | Accepting new patients | |
| Des Moines Pediatric & Adolescent Clinic | Pediatrics | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Critical Access Hospital
- Boone, IA
- NPI 1467434225
-
- Pediatrics Physician
- Des Moines, IA
- NPI 1194991109
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1902877707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2301 BEAVER AVE",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503103903",
"telephone_number": "515-255-3181",
"fax_number": "515-255-9392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 BEAVER AVE",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503103903",
"telephone_number": "515-255-3181",
"fax_number": "515-255-9392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORNOFF",
"first_name": "ROBERT",
"middle_name": "ADAM",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-30",
"last_updated": "2020-10-14",
"certification_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IA",
"license": "35011",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-EAST",
"identifier": "20764",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-WEST",
"identifier": "20794",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0431916",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.