Bettendorf Pediatric Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BETTENDORF PEDIATRIC GROUP

Practice address

4017 Devils Glen Rd
Suite 200
Bettendorf, IA 52722-7259

Phone

(563) 332-3400

Fax

(563) 332-4784

NPI assigned

Jun 11, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Pomilla Kumar, MDNPI 1568431880

Title

Owner

Phone

(563) 332-3400

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pomilla Kumar, M.D.

  • Family Medicine Physician
  • Bettendorf, IA
  • NPI 1568431880

  IA

  Medicare reassignment Authorized official
• Victoria I Rowlands, ARNP

  • Nurse Practitioner
  • Bettendorf, IA
  • NPI 1013995695

  IA

  Medicare reassignment
• Steven Foster Burke, P.A.-C.

  • Medical Physician Assistant
  • Columbus City, IA
  • NPI 1780659623
  NPD (past)
• Alisha Kumar, M.D.

  • Pediatrics Physician
  • Des Moines, IA
  • NPI 1225476310

  Pediatrics

  NPD (past)
• Narinder Kumar, M.D.

  • Pediatrics Physician
  • Bettendorf, IA
  • NPI 1245205269

  Pediatrics

  NPD (past)
• Renee Diane Lass, DO

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1174584445

  Family Medicine

  NPD (past)
• Linda M Stephens, ARNP

  • Nurse Practitioner
  • Moline, IL
  • NPI 1356343420
  NPD (past)

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339372800000",
    "number": "1942562467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4017 DEVILS GLEN RD",
            "address_2": "SUITE 200",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527227259",
            "telephone_number": "563-332-3400",
            "fax_number": "563-332-4784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4017 DEVILS GLEN RD",
            "address_2": "SUITE 200",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527227259",
            "telephone_number": "563-332-3400",
            "fax_number": "563-332-4784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETTENDORF PEDIATRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2012-06-11",
        "status": "A",
        "authorized_official_last_name": "KUMAR",
        "authorized_official_first_name": "POMILLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-332-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bettendorf Dental PC
• Bettendorf Healthcare Management LLC
• Bettendorf Ia SNF Opco LLC
• Bettendorf Nursing and Rehabilitation LLC
• Bettendorf Nursing Home Company
• BHK, Inc
• Randall Dale Bickford, R.PH.
• Ashley Katherine Binks, MOT, OTR L
• Paul Ralph Black Jr., D.D.S.
• Trina Gebauer Blair, PAC

• All providers in Bettendorf, IA
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.