Active NPI
Teresa Pangan, PHD, RDN
- Registered Dietitian
- Bettendorf, IA
National Provider Identifier
1962271098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164007279
- Practice address
- 3885 Tam O Shanter Dr N Apt Suite
Bettendorf, IA 52722-1945 - Phone
- (469) 667-0000
- NPI assigned
- Dec 29, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 072249 | IA | |
| Registered Dietitian | 133V00000X | 164007279 | IL | Primary |
Addresses
Primary practice location
3885 Tam O Shanter Dr N Apt Suite
Bettendorf, IA 52722-1945
Mailing address
3885 Tam O Shanter Dr N
Bettendorf, IA 52722-1945
Phone (469) 667-0000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5250 Old Orchard Rd
Suite 300
Skokie, IL 60077-4462
Phone (563) 241-5543
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 072249 | IA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teresa Pangan PLLC | Dietitian, Registered | Current | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703808000000",
"number": "1962271098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3885 TAM O SHANTER DR N",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527221945",
"telephone_number": "469-667-0000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3885 TAM O SHANTER DR N APT SUITE",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527221945",
"telephone_number": "469-667-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANGAN",
"first_name": "TERESA",
"credential": "PHD, RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-29",
"last_updated": "2023-12-29",
"certification_date": "2023-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "072249",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164007279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bettendorf, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; 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.