NPIMap

Individual provider Active NPI

Teri S Formanek, M.D.

  • Orthopaedic Surgery Physician
  • Winterset, IA
National Provider Identifier
1982644993
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
26239 Issued in IA
Practice address
300 W Hutchings St
Winterset, IA 50273
Phone
(515) 462-2373
NPI assigned
Jun 7, 2006
Last updated
Feb 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 26239 IA Primary

Addresses

Primary practice location

300 W Hutchings St
Winterset, IA 50273

Mailing address

300 W Hutchings St
Winterset, IA 50273-2109
Phone (515) 462-2373

Other practice location 1

12499 University Ave
Suite 210
Clive, IA 50325-8281
Phone (515) 440-2676

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tformanek@madisonhealth.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100602000422 IA Practitioner - Hand SurgeryPractitioner - Orthopedic Surgery 6204828890 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hand SurgeryAlso: Orthopedic Surgery
Education
University of Iowa, RJ & L Carver College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Madison County Memorial HospitalGroup PAC ID 6002727179, shared by 5 NPIs, 42 clinicians
Adair County Memorial HospitalGroup PAC ID 3072403153, shared by 6 NPIs, 15 clinicians

Practice addresses (Care Compare)

300 W Hutchings St
Winterset, IA 50273-2109

609 SE Kent St
Greenfield, IA 50849-9494
Phone (641) 743-2123

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26239IAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Madison County Memorial Hospital CurrentSince Aug 1, 2019 Accepting new patients
Madison County Memorial Hospital CurrentSince Aug 1, 2019 Accepting new patients
Adair County Memorial Hospital CurrentSince Jul 1, 2019 Accepting new patients
Adair County Memorial Hospital CurrentSince Jul 1, 2019 Accepting new patients
Adair County Memorial Hospital Current Accepting new patients
Madison County Memorial Hospital Current Accepting new patients
Center for Occupational and Physical Medicine PastSince Jun 16, 2012 Accepting new patients
Madison County Memorial Hospital Past Accepting new patients
Metro Orthopaedic Surgery, P.C. Orthopaedic Surgery PastSince Jun 17, 2002 Accepting new patients

Locations

609 SE Kent St
Greenfield, IA 50849
Phone (641) 743-2123

300 W Hutchings St
Winterset, IA 50273
Phone (515) 223-4368

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/823d67d6-97c5-40a2-b084-56d06cb82099/
  • FHIR API: https://fhir-myrecord.cerner.com/r4/f904b187-16a4-4582-8ea3-887d87de0011/
  • FHIR API: https://fhir-usa.unify.chbase.com/org/madico-8e3b1615
  • Direct secure messaging: tformanek@madisonhealth.cernerdirect.com

Organizations & group practices 9

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1982644993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W HUTCHINGS ST",
            "city": "WINTERSET",
            "state": "IA",
            "postal_code": "502732109",
            "telephone_number": "515-462-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W HUTCHINGS ST",
            "city": "WINTERSET",
            "state": "IA",
            "postal_code": "50273",
            "telephone_number": "515-462-2373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12499 University Ave",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Clive",
            "state": "IA",
            "postal_code": "503258281",
            "country_code": "US",
            "telephone_number": "515-440-2676",
            "fax_number": "515-245-6422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORMANEK",
        "first_name": "TERI",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IA",
            "license": "26239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tformanek@madisonhealth.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Madison County Health Care System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "300 W Hutchings St",
            "city": "Winterset",
            "state": "IA",
            "country_code": "US",
            "postal_code": "50273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winterset, IA

Sources for this page

Verify at the official NPI Registry.