NPIMap

Individual provider Active NPI

Richard T Kettelkamp, DO

  • Interventional Cardiology Physician
  • Cedar Rapids, IA
National Provider Identifier
1922042894
Registry record updated Nov 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
3618 Issued in IA
Practice address
202 10TH St SE
Suite 225
Cedar Rapids, IA 52403-2404
Phone
(319) 364-7101
NPI assigned
Jun 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 3618 IA
Interventional Cardiology Physician 207RI0011X 3618 IA Primary

Addresses

Primary practice location

202 10TH St SE
Suite 225
Cedar Rapids, IA 52403-2404

Mailing address

202 10TH St SE
Suite 225
Cedar Rapids, IA 52403-2404
Phone (319) 364-7101

Other identifiers 2

IdentifierTypeStateIssuer
1922042894MedicaidIA
P00823157OtherIARR MEDICARE

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
I20060421000387 IA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Interventional Cardiology 0749290674 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Finley HospitalGroup PAC ID 5092622944, 84 clinicians
St Lukes Methodist HospitalGroup PAC ID 6608786751, 82 clinicians

Practice addresses (Care Compare)

1500 Delhi St
Suite 4300
Dubuque, IA 52001-6319
Phone (563) 557-5971

202 10TH St SE
Suite 225
Cedar Rapids, IA 52403-2419
Phone (319) 368-5757

350 N Grandview Ave
Dubuque, IA 52001-6388

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Cedar Rapids, IA, CCN 160045
  • Finley Hospital Hospital, Dubuque, IA, CCN 160117
  • Jones Regional Medical Center Hospital, Anamosa, IA, CCN 161306
  • Regional Medical Center Hospital, Manchester, IA, CCN 161343
  • Buchanan County Health Center Hospital, Independence, IA, CCN 161335

Merit-based Incentive Payment System (MIPS)

Final score
81.6 of 100Reported as group
Quality
83.66
Promoting interoperability
83
Improvement activities
40
Cost
69.17

Merit-based Incentive Payment System (MIPS)

Final score
80.76 of 100Reported as group
Quality
75.82
Promoting interoperability
81
Improvement activities
40
Cost
75.88

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting58
Pacemaker insertion or repair1-10
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3618IAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allen Memorial Hospital Corporation Current Accepting new patients
The Finley Hospital CurrentSince Feb 1, 2024 Accepting new patients
The Finley Hospital CurrentSince Feb 1, 2024 Accepting new patients
Allen Memorial Hospital Corporation CurrentSince Jun 8, 2024 Accepting new patients
Trinity Regional Medical Center Past Accepting new patients
The Finley Hospital Cardiovascular Disease Past Accepting new patients
University Health Physicians Cardiovascular Disease Past Accepting new patients

Locations

1026 A Ave NE
Cedar Rapids, IA 52402
Phone (319) 369-5970

250 Mercy Dr
Dubuque, IA 52001
Phone (563) 589-8000

350 N Grandview Ave
Dubuque, IA 52001
Phone (563) 582-1881

1500 Delhi St
Ste 4300
Dubuque, IA 52001
Phone (563) 557-5971

1600 1st St E
Independence, IA 50644
Phone (319) 332-0999

419 E Donald St
Waterloo, IA 50703
Phone (319) 888-7604

1825 Logan Ave
Waterloo, IA 50703
Phone (319) 235-3886

Interoperability endpoints

  • Direct secure messaging: rkettelkamp40878@direct.unitypoint.org

Organizations & group practices 16

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 16

Hospital & facility affiliations 5

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": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542758400000",
    "number": "1922042894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 10TH ST SE",
            "address_2": "SUITE 225",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524032404",
            "telephone_number": "319-364-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 10TH ST SE",
            "address_2": "SUITE 225",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524032404",
            "telephone_number": "319-364-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTELKAMP",
        "first_name": "RICHARD",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2018-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IA",
            "license": "3618",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IA",
            "license": "3618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922042894",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00823157",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

Verify at the official NPI Registry.