Provider Demographics
| NPI: | 1326294463 |
|---|---|
| Name: | JEROME R. GREENBERG, O.D., P.C. |
| Entity Type: | Organization |
| Organization Name: | JEROME R. GREENBERG, O.D., P.C. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | JEROME |
| Authorized Official - Middle Name: | RICHARD |
| Authorized Official - Last Name: | GREENBERG |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | OD |
| Authorized Official - Phone: | 515-263-0295 |
| Mailing Address - Street 1: | 1242 E 14TH ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DES MOINES |
| Mailing Address - State: | IA |
| Mailing Address - Zip Code: | 50316-2402 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 515-263-0295 |
| Mailing Address - Fax: | 515-263-0115 |
| Practice Address - Street 1: | 1242 E 14TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | DES MOINES |
| Practice Address - State: | IA |
| Practice Address - Zip Code: | 50316-2402 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 515-263-0295 |
| Practice Address - Fax: | 515-263-0115 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2008-08-08 |
| Last Update Date: | 2008-10-27 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| IA | 01709 | 261Q00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IA | 17996 | Other | FIRST ADMINISTRATORS |
| IA | 17996 | Other | MUTUAL OF OMAHA |
| IA | 6155 | Other | MIDLANDS CHOICE |
| IA | 0000 | Other | TRIWEST |
| IA | 81376 | Other | COVENTRY HEALTHCARE |
| IA | 0005314 | Medicaid | |
| IA | 17996 | Other | WELLMARK BLUE SHIELD |
| IA | IA0101 | Other | UNITED HEALTHCARE OF THE RIVER VALLEY |
| IA | 81376 | Other | COVENTRY ADVANTRA |
| IA | 410020694 | Other | RAILROAD MEDICARE |
| IA | 81376 | Other | ADVANTRA FREEDOM |
| IA | ========= | Other | TODAY'S OPTIONS |
| IA | ========= | Other | GUARANTEE TRUST LIFE INS. CO. |
| IA | ========= | Other | UNITED AMERICAN INSURANCE COMPANY |
| IA | 410020694 | Other | RAILROAD MEDICARE |
| IA | ========= | Other | SECUREHORIZONS |
| IA | ========= | Other | AUTO OWNERS, PRAIRIE STATES |
| IA | ========= | Other | BANKERS LIFE |
| IA | 81376 | Other | COVENTRY HEALTHCARE |
| IA | ========= | Other | HUMANA |
| IA | 6155 | Other | MIDLANDS CHOICE |
| IA | ========= | Other | FEDERATED INSURANCE |
| IA | ========= | Other | AMERICARE |
| IA | ========= | Other | PRINCIPAL HEALTHCARE |
| IA | ========= | Other | EBC (EMPLOYEE BENEFIT CONSULTANTS) |
| IA | ========= | Other | UNICARE |
| IA | ========= | Other | ADVANTICA EYECARE |
| IA | ========= | Other | AMERICAN REPUBLIC |
| IA | ========= | Other | AARP |
| IA | 0005314 | Medicaid | |
| IA | 81376 | Other | ADVANTRA FREEDOM |
| IA | ========= | Other | MEDICARE COMPLETE |
| IA | ========= | Other | ACCOUNTABLE HEALTH |
| IA | 81376 | Other | COVENTRY ADVANTRA |
| IA | ========= | Other | SOUTHERN BENEFIT ADMINISTRATORS INC |
| IA | ========= | Other | BRIDGESTONE/FIRESTONE |
| IA | ========= | Other | PIRELLI ARMSTRONG |
| IA | ========= | Other | UNITED HEALTHCARE |
| IA | ========= | Other | GUARANTEE TRUST LIFE INS. CO. |
| IA | 17996 | Medicare PIN |
