NPIMap

Organization Active NPI

Capital Orthopaedics and Sports Medicine PC

  • Orthopaedic Surgery Physician
  • Clive, IA
National Provider Identifier
1932432457
Registry record updated Jan 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
CAPITAL ORTHOPAEDICS AND SPORTS MEDICINE PC
Practice address
12499 University Ave
Suite 210
Clive, IA 50325-8281
Phone
(515) 440-2676
Fax
(515) 440-2677
NPI assigned
Sep 16, 2009
Last updated
Jan 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2013

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

Authorized official

Name
Dr. William Charles Jacobson, MDNPI 1790749448
Title
Shareholder
Phone
(515) 440-2676

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X IA Primary
Orthopaedic Hand Surgery Physician 207XS0106X 26239 IA
Orthopaedic Surgery of the Spine Physician 207XS0117X 19337 IA
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 33389 IA
Physical Medicine & Rehabilitation Physician 208100000X 27587 IA
Surgery of the Hand (Surgery) Physician 2086S0105X 37744 IA
Foot & Ankle Surgery Podiatrist 213ES0103X 00693 IA

Addresses

Primary practice location

12499 University Ave
Suite 210
Clive, IA 50325-8281

Mailing address

12499 University Ave
Suite 210
Clive, IA 50325-8281
Phone (515) 440-2676

Other identifiers 1

IdentifierTypeStateIssuer
1932432457MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091110000451 IA Part B Supplier - Clinic/Group Practice 3476691551 Receives reassigned benefits from 20 practitioners
Practice locations: Ames, IA; Ankeny, IA; Boone, IA; Clive, IA; Indianola, IA
O20110208000991 IA DME Supplier - Physician - General Practice 3476691551 Practice locations: Clive, IA

National Provider Directory

National Provider Directory

Locations

1345 SW Park Square Dr
Ste 200
Ankeny, IA 50023

1510 SW Oralabor Rd
Ankeny, IA 50023

800 E 1st St
Ste E230
Ankeny, IA 50021
Phone (515) 223-0119

2006 N 4th St
Ste 300
Indianola, IA 50125

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19659/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358812800000",
    "number": "1932432457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12499 UNIVERSITY AVE",
            "address_2": "SUITE 210",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258281",
            "telephone_number": "515-440-2676",
            "fax_number": "515-440-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12499 UNIVERSITY AVE",
            "address_2": "SUITE 210",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258281",
            "telephone_number": "515-440-2676",
            "fax_number": "515-440-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL ORTHOPAEDICS AND SPORTS MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-16",
        "last_updated": "2013-01-22",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "SHAREHOLDER",
        "authorized_official_telephone_number": "515-440-2676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IA",
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "IA",
            "license": "26239",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "IA",
            "license": "19337",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IA",
            "license": "33389",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IA",
            "license": "27587",
            "primary": false
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgery of the Hand",
            "state": "IA",
            "license": "37744",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IA",
            "license": "00693",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932432457",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.