Individual provider Active NPI

Stephanie Witherow, FNP

  • Family Nurse Practitioner
  • Davenport, IA
National Provider Identifier
1003224585
Registry record updated Feb 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A115535 Issued in IA
Practice address
500 W River Dr
Davenport, IA 52801-1014
Phone
(563) 336-3000
Fax
(563) 336-3125
NPI assigned
Jul 28, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 115535 IA
Family Nurse Practitioner 363LF0000X A115535 IA Primary

Addresses

Primary practice location

500 W River Dr
Davenport, IA 52801-1014

Mailing address

500 W River Dr
Davenport, IA 52801-1014
Phone (563) 336-3000

Other identifiers 1

IdentifierTypeStateIssuer
1932193224MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141119001949 IA Practitioner - Nurse Practitioner 1153543517 Reassigns benefits to 1 organization
I20170202002113 IL Practitioner - Nurse Practitioner 1153543517 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
115535IAMDRegistered Nurse
A115535IAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Care Inc CurrentSince Sep 24, 2014 Accepting new patients
Community Health Care, Inc. Current Accepting new patients
Community Health Care, Inc. CurrentSince Dec 31, 2016 Accepting new patients
Community Health Care, Inc. CurrentSince Sep 24, 2014 Accepting new patients
Community Health Care, Inc. Current Accepting new patients

Locations

500 W River Dr
Davenport, IA 52801
Phone (563) 327-2035

1106 4th Ave
Moline, IL 61265
Phone (309) 623-4817

2750 11th St
Rock Island, IL 61201
Phone (563) 327-2000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HEDCAA
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517875200000",
    "number": "1003224585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITHEROW",
        "first_name": "STEPHANIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-28",
        "last_updated": "2018-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IA",
            "license": "115535",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A115535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932193224",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.