CHARLES ANTHONY JENNISSEN (NPI# 1033194188) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033194188 |
| Entity Type | Individual |
| Full Name | CHARLES ANTHONY JENNISSEN |
| Credential | MD |
| Practice Address |
200 Hawkins Dr Iowa City IA 52242-1009 |
| Practice Telephone | 3193566360 |
| Practice Fax Number | 3193849184 |
| Mailing Telephone | 3193566360 |
| Mailing Fax Number | 3193849184 |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2007-12-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0204X |
Pediatrics Specialization: Pediatric Emergency Medicine |
26724 | IA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | WELLMARK BCBS | 34154 | 01 |
| IA | 1101659 | 05 |
| Street Address |
200 HAWKINS DR |
| City | IOWA CITY |
| State | IA |
| Zip Code | 52242-1009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164425963 | Matthew T Spragg | Emergency Medicine | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2005-05-24 |
| 1205437951 | Jennifer Renee Manternach | Nurse Practitioner | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2020-11-07 |
| 1144821794 | Jannet S Eastman | Nurse Practitioner | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2020-11-02 |
| 1043810245 | Abbey Lorraine Foglesong | Dietitian, Registered | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2020-10-27 |
| 1972101533 | Lindy Pelzer | Nurse Practitioner | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2020-10-15 |
| 1124626437 | Georgianne Younger | Genetic Counselor, MS | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2020-10-09 |
| 1114534237 | Bharatendu Chandra | Medical Genetics | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2020-09-24 |
| 1023625142 | Moon Ley Tung | Medical Genetics | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2020-09-24 |
| 1225645187 | Sinan Akay | Radiology | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2020-09-24 |
| 1376158170 | Aygun Asgarli | Psychiatry & Neurology | 200 Hawkins Dr, Iowa City, IA 52242-1009 | 2020-09-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033738679 | Shannon Louise Miers | Physical Therapist | Ui Sports Medicine (iosmr), 2701 Prairie Meadow Drive, Iowa City, IA 52242 | 2020-04-14 |
| 1821624230 | Victoria Troesch | Student in an Organized Health Care Education/Training Program | 375 Newton Rd, Iowa City, IA 52242 | 2020-03-17 |
| 1891338539 | Kira Ann Hennes Blum | Dietitian, Registered | 930 Evashevski Dr., Jacobson Building, Iowa City, IA 52242 | 2019-10-25 |
| 1407330483 | Kristin L Heider | Psychologist | 616 E Bloomington Street, Iowa City, IA 52242 | 2018-09-17 |
| 1447738398 | Allison Kral | Dietitian, Registered | 200 Hawkins Dr. W146 Gh, Iowa City, IA 52242 | 2018-08-02 |
| 1528544780 | Abigail Lynne Schiltz | Physician Assistant | 200 Hawkins Dr 01290a Pfp, Iowa City, IA 52242 | 2018-07-11 |
| 1710474259 | Bashar H. H. Abuqayas | Hospitalist | 200 Hawkins Dr, Se 636 Gh, Uihc-internal Medicine, Iowa City, IA 52242 | 2018-04-19 |
| 1023547395 | Tyler Quist | Internal Medicine | 200 Hawkins Dr Dept of Ophthalmology, Iowa City, IA 52242 | 2017-06-08 |
| 1972962371 | Angeleah Korin Whitlatch | Social Worker | 100 Hawking Drive, Iowa City, IA 52242 | 2016-02-15 |
| 1649667734 | Jennie Sertterh | Specialist/Technologist | 1 Elliot Drive, S181 Carver Hawkeye Arena, Iowa City, IA 52242 | 2015-04-16 |
| Find all providers in zip 52242 | ||||
| Taxonomy Code | 2080P0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Emergency Medicine |
| A pediatrician who has special qualifications to manage emergencies in infants and children. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992790273 | Tameem A Shoukih | Pediatrics | 200 Hawkins Dr, Iowa City, IA 52242 | 2005-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821058868 | Jill M Jasper | Pediatrics | 1200 Pleasant Street, Blank Children's Hospital, Des Moines, IA 50309 | 2006-03-24 |
| 1245641240 | John Odome | Pediatrics | 1111 6th Ave, Des Moines, IA 50314-2613 | 2014-05-13 |
| 1114213451 | Tyler J Fisher | Pediatrics | 1200 Pleasant St, Des Moines, IA 50309-1406 | 2011-06-24 |
| 1497728612 | Steven T Dawson | Pediatrics | 1111 6th Ave, Pediatric Emergency Department, Des Moines, IA 50314-2613 | 2006-02-08 |
| 1821078940 | Amy Marie Groen | Pediatrics | 1200 Pleasant St, Des Moines, IA 50309-1406 | 2006-01-17 |
| 1245214436 | Julie L Anderson-suddarth | Pediatrics | 1200 Pleasant St, Pediatric Emergency Department, Des Moines, IA 50309-1406 | 2005-12-01 |
| 1700860806 | Lydia J Holm | Pediatrics | 1200 Pleasant St, Blank Administration, Des Moines, IA 50309-1406 | 2005-12-01 |
| 1689656431 | David L Thornton | Pediatrics | 1200 Pleasant St, Blank Administration, Des Moines, IA 50309-1406 | 2005-11-17 |
| 1922092030 | Vidya T Chande | Pediatrics | 1200 Pleasant St, Blank Childrens Hospital, Des Moines, IA 50309-1406 | 2005-09-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.