NPIMap

Organization Active NPI

State University of Iowa

Doing business as University of Iowa Health Care-Quad Cities

  • Dermatology Physician
  • Bettendorf, IA
National Provider Identifier
1972955169
Registry record updated Jul 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
STATE UNIVERSITY OF IOWA
Doing business as
University of Iowa Health Care-Quad Cities
Practice address
865 Lincoln Rd
Bettendorf, IA 52722-4190
Phone
(563) 344-2240
Fax
(563) 344-2244
NPI assigned
Jul 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2016

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

Authorized official

Name
Philip E Roudabush
Title
Assistant Vice President
Phone
(319) 353-8820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

865 Lincoln Rd
Bettendorf, IA 52722-4190

Mailing address

200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 356-1616

Other names 1

  • University of Iowa Health Care-Quad Cities Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000060 IA Part B Supplier - Clinic/Group Practice 7618884230 Receives reassigned benefits from 2,348 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 36

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

View all 36

National Provider Directory

National Provider Directory

Locations

1632 Sycamore St
Iowa City, IA 52240
Phone (319) 467-8350

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468800000000",
    "number": "1972955169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-356-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 LINCOLN RD",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224190",
            "telephone_number": "563-344-2240",
            "fax_number": "563-344-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE UNIVERSITY OF IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-12",
        "last_updated": "2016-07-18",
        "status": "A",
        "authorized_official_last_name": "ROUDABUSH",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ASSISTANT VICE PRESIDENT",
        "authorized_official_telephone_number": "319-353-8820"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University of Iowa Health Care-Quad Cities",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 18, 2016; 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.