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  7. NPI Record 1508843681

ANN MARIE WORDEKEMPER PA
Complete NPI Record 1508843681
Physician Assistant in Council Bluffs, IA

NPI Status: Active since December 29, 2005

Contact Information

1 EDMUNDSON PL
COUNCIL BLUFFS, IA
ZIP 51503
Phone: (712) 396-4340
Fax: (712) 396-4180

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Provider Gender Code
  24. Healthcare Provider Taxonomy Code 1
  25. Provider License Number 1
  26. Provider License Number State Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Healthcare Provider Taxonomy Code 2
  29. Provider License Number 2
  30. Provider License Number State Code 2
  31. Healthcare Provider Primary Taxonomy Switch 2
  32. Other Provider Identifier 1
  33. Other Provider Identifier Type Code 1
  34. Other Provider Identifier State 1
  35. Other Provider Identifier 2
  36. Other Provider Identifier Type Code 2
  37. Other Provider Identifier State 2
  38. Other Provider Identifier 3
  39. Other Provider Identifier Type Code 3
  40. Other Provider Identifier State 3
  41. Other Provider Identifier 4
  42. Other Provider Identifier Type Code 4
  43. Other Provider Identifier State 4
  44. Other Provider Identifier 5
  45. Other Provider Identifier Type Code 5
  46. Other Provider Identifier State 5
  47. Other Provider Identifier 6
  48. Other Provider Identifier Type Code 6
  49. Other Provider Identifier State 6
  50. Other Provider Identifier 7
  51. Other Provider Identifier Type Code 7
  52. Other Provider Identifier State 7
  53. Other Provider Identifier 8
  54. Other Provider Identifier Type Code 8
  55. Other Provider Identifier State 8
  56. Other Provider Identifier 9
  57. Other Provider Identifier Type Code 9
  58. Other Provider Identifier State 9
  59. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1508843681. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1508843681
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: ANN
The first name of the provider, if the provider is an individual.
Provider Middle Name: MARIE
The middle name of the provider, if the provider is an individual.
Provider Credential Text: PA
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: PO BOX 3755
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: OMAHA
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NE
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 681030755
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 4023542100
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 4023542155
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1 EDMUNDSON PL
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: COUNCIL BLUFFS
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: IA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 515034658
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7123964340
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7123964180
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 12/29/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 5/1/2017
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 363A00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 001158
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: IA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Healthcare Provider Taxonomy Code 2: 363A00000X
Provider License Number 2: 1477
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: NE
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Other Provider Identifier 1: 47068731785
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: NE
Other Provider Identifier 2: 10025464000
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: NE
Other Provider Identifier 3: 10026480100
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Other Provider Identifier Type Code 3: 05
The country code in the location address of the provider being identified.
Other Provider Identifier State 3: NE
The telephone number associated with the location address of the provider being identified.
Other Provider Identifier 4: 47068731712
The fax number associated with the location address of the provider being identified.
Other Provider Identifier Type Code 4: 05
The date the provider was assigned a unique identifier (assigned an NPI).
Other Provider Identifier State 4: NE
The date that a record was last updated or changed.
Other Provider Identifier 5: 1508813681
The code designating the provider’s gender if the provider is a person.
Other Provider Identifier Type Code 5: 05
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Other Provider Identifier State 5: IA
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Other Provider Identifier 6: 47068731734
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Other Provider Identifier Type Code 6: 05
Other Provider Identifier State 6: NE
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Other Provider Identifier 7: 47068731741
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: NE
Other Provider Identifier 8: 47068731777
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: NE
Other Provider Identifier 9: 47068731749
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: NE
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No