NPIMap

Organization Active NPI

Iowa Dermatology Clinic PLC

Doing business as Radiant Complexions Dermatology Clinic

  • Dermatology Physician
  • West Des Moines, IA
National Provider Identifier
1972023414
Registry record updated Mar 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
IOWA DERMATOLOGY CLINIC PLC
Doing business as
Radiant Complexions Dermatology Clinic
Practice address
9500 University Ave Ste 1114
West Des Moines, IA 50266-1745
Phone
(515) 221-8960
NPI assigned
Jun 26, 2017
Last updated
Mar 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2018

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

Authorized official

Name
Dr. Charles Love, MDNPI 1043312432
Title
President
Phone
(515) 226-8484

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

9500 University Ave Ste 1114
West Des Moines, IA 50266-1745

Mailing address

6800 Lake Dr Ste 285
West Des Moines, IA 50266-2544
Phone (515) 226-3116

Other names 1

  • Radiant Complexions Dermatology Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000335 IA Part B Supplier - Clinic/Group Practice 2961394713 Receives reassigned benefits from 25 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshalltown, IA; Cedar Rapids, IA; Mason City, IA; Norwalk, IA; Storm Lake, IA; Urbandale, IA; West Des Moines, IA; Grinnell, IA…

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory

Locations

9500 University Ave
Ste 1114
West Des Moines, IA 50266
Phone (515) 221-8960

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522195200000",
    "number": "1972023414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 LAKE DR STE 285",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502662544",
            "telephone_number": "515-226-3116",
            "fax_number": "888-391-9262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 UNIVERSITY AVE STE 1114",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661745",
            "telephone_number": "515-221-8960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IOWA DERMATOLOGY CLINIC PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-26",
        "last_updated": "2018-03-28",
        "status": "A",
        "authorized_official_last_name": "LOVE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "515-226-8484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Radiant Complexions Dermatology Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Radiant Complexions Dermatology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; 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.