Stadia Sports Medicine PC
Organization Active NPI Sports Medicine (Neuromusculoskeletal Medicine) Physician · West Des Moines, IA
NPI 1962453274 · NPPES record last updated Jul 10, 2026
Key facts
- NPI
- 1962453274
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X
- License
- 36501 (IA)
- Legal business name
- STADIA SPORTS MEDICINE PC
- Practice address
- 7601 Office Plaza Dr N Ste 140
West Des Moines, IA 50266-1207 - Phone
- (515) 221-1102
- Fax
- (515) 221-1272
- NPI assigned
- May 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Chad Thomas Carlson, M.D.
- Title
- Ceo, Stadia Sports Medicine
- Phone
- (515) 221-1102
Practitioners 19
-
Chad Thomas Carlson, M.D.
-
Samuel I Huey, DPT
-
Detlef James Maltas, DPT
-
Phillip McCullough, DPT
-
Catherine M Mitchell, DPT
-
Robert W Mortenson, DPT
-
Derek Klein, DPT
-
Todd D Hixson, PT
-
Jordan Dielmann, ATC
-
Katherine Hatting, ATC
-
Peter Dwight Wirtz, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060804000090 | IA | Part B Supplier - Clinic/Group Practice | 4284647579 |
Receives reassigned benefits from 14 practitioners Practice locations: West Des Moines, IA |
| O20240528000715 | IA | DME Supplier - Multi-Specialty - Physician | 4284647579 | Practice locations: West Des Moines, IA |
National Provider Directory
Locations
7601 Office Plaza Dr N
Ste 140
West Des Moines, IA 50266
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Neuromusculoskeletal Medicine) Physician |
204C00000X | 36501 | IA | Yes |
| Physical Therapist |
225100000X |
Addresses
Primary practice location
7601 Office Plaza Dr N Ste 140
West Des Moines, IA 50266-1207
Mailing address
7601 Office Plaza Dr N Ste 140
West Des Moines, IA 50266-1207
Phone (515) 221-1102
Other providers in West Des Moines, IA
- Spirit ABA Ia LLC
- Springbrook Clinical & Consulting, LLC
- Square One Counseling, Inc.
- St. Gregory Recovery Center, LLC
- Stacie Weires Counseling LLC
- Alexandria Nicole Stafford
- Paula Elizabeth Stageman
- Stagner Counseling
- Molly McMahon Stagner
- Jeffrey D Stahl
All providers in West Des Moines, IA · Sports Medicine (Neuromusculoskeletal Medicine) Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.