OrganizationActive
State University of Iowa
NPI 1700835865 · Family Medicine Physician · Centerville, IA
Provider details
- NPI number
- 1700835865
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kenneth Fisher, Cfo(319) 384-2844
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
19876 St. Joseph Drive
Centerville, IA 52544
Phone: (641) 856-8684
Street-level locationGet directions
Mailing address
2941 Sierra Ct Sw
Iowa City, IA 52240-8503
Other names (DBA / former)
- Doing business as
- Centerville Medical Clinic
Registry dates
- Enumerated
- 2006-05-08
- Last updated
- 2009-07-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.