CLINTON KEITH CUNNINGHAM – Marriage & Family Therapist, NPI 1215410741

CLINTON KEITH CUNNINGHAM is a healthcare provider. based in Cedar rapids, Iowa. specializing in MARRIAGE AND FAMILY THERAPIST. They hold a License No. 087027 (IA). The NPI Number for CLINTON KEITH CUNNINGHAM is 1215410741

Main info

Male
9 Years Of Experience
Name
CLINTON KEITH CUNNINGHAM
NPI
1215410741
Phone
(319) 361-6529
Address
3726 QUEEN CT SW STE 103
Enumeration Date
11 September 2018
Last Update Date
13 October 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6415190467
Graduation Year
2017 (9 years ago)
PAC ID
4183061583
Group Practice PAC ID
1052722147
Professional Enrollment ID
I20240321000120
Address ID
IA501128101GR213XXSXXX400
Telehealth
Yes

Contacts

Secure Messaging
prhc@direct.pellahealth.kobledirect.com
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience38
Completeness85
Years active:7State licenses:1Other namesUpdated within 12 months

88 MARRIAGE AND FAMILY THERAPIST in IA

Provider Addresses for CLINTON KEITH CUNNINGHAM

  • 3726 QUEEN CT SW STE 103

    CEDAR RAPIDS, IA 524043903

    Phone: (319) 361-6529

    Type: Location

  • 508, Forest Drive Southeast, Vernon Heights, Cedar Rapids, Linn County, Iowa, 52403, United States

    CEDAR RAPIDS, IA 524034235

    Phone: (641) 799-1252

    Fax: (319) 369-7749

    Type: Mailing

  • 405 MONROE ST

    PELLA, IA 502191290

    Phone: (641) 621-2200

    Fax: (641) 621-2335

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-03-21

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240321000120IMarriage And Family TherapistIATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 52404)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1052722147View full group profile
NameSpecialtyState
Nurse PractitionerIL
Nurse PractitionerIA
Nurse PractitionerTN
Nurse PractitionerIA
Nurse PractitionerIA
Nurse PractitionerIA
Nurse PractitionerIA
Nurse PractitionerIL
Nurse PractitionerIA
Nurse PractitionerIA

Reviews

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Frequently asked questions

How do payers reference CLINTON KEITH CUNNINGHAM?
For CLINTON KEITH CUNNINGHAM, use NPI 1215410741 as the unique 10-digit identifier.
Is CLINTON KEITH CUNNINGHAM still an active registrant?
CLINTON KEITH CUNNINGHAM carries an active NPI according to the public dataset.
What area of care is associated with CLINTON KEITH CUNNINGHAM?
CLINTON KEITH CUNNINGHAM's record emphasizes Marriage & Family Therapist. Clinical services aligned with this taxonomy classification.
Is CLINTON KEITH CUNNINGHAM located near Cedar Rapids?
CLINTON KEITH CUNNINGHAM currently maps to Cedar Rapids, Iowa in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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