Individual provider Active NPI

Susan Mirembe Matovu, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Des Moines, IA
National Provider Identifier
1952088437
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
G175028 Issued in IA
Practice address
1801 Hickman Road
Des Moines, IA 50314
Phone
(515) 282-5742
NPI assigned
Jun 28, 2023
Last updated
Jun 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X G175028 IA Primary

Addresses

Primary practice location

1801 Hickman Road
Des Moines, IA 50314

Mailing address

920 NE 41St St
Ankeny, IA 50021-6710

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241227000258 IA Practitioner - Nurse Practitioner 8820525199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Broadlawns Medical CenterGroup PAC ID 3678466166, 302 clinicians

Practice addresses (Care Compare)

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Broadlawns Medical Center CurrentSince Oct 11, 2024 Accepting new patients
Broadlawns Medical Center CurrentSince Oct 11, 2024 Accepting new patients

Locations

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

2508 E University Ave
Des Moines, IA 50317
Phone (515) 282-2362

2970 University Ave
Des Moines, IA 50311
Phone (515) 216-5100

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1952088437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 NE 41ST ST",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500216710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 HICKMAN ROAD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "50314",
            "telephone_number": "515-282-5742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIREMBE MATOVU",
        "first_name": "SUSAN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-28",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G175028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.