NPIMap

Organization Active NPI

Ora Orthopedics PC

  • Orthopaedic Surgery Physician
  • Geneseo, IL
National Provider Identifier
1023089323
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
060006850 Issued in IL
Legal business name
ORA ORTHOPEDICS PC
Practice address
1225 S Oakwood Ave Ste 7B
Geneseo, IL 61254-1990
Phone
(309) 762-3621
Fax
(309) 762-3690
NPI assigned
Jan 27, 2006
Organization subpart
Yes
Parent organization
ORA ORTHOPEDICS, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Kenneth Brockman
Title
Ceo
Phone
(563) 322-0971

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WM0705X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X 060006850 IL Primary
Other Specialist/TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 246Z00000X
Durable Medical Equipment & Medical Supplies 332B00000X
Prosthetic/Orthotic Supplier 335E00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1225 S Oakwood Ave Ste 7B
Geneseo, IL 61254-1990

Mailing address

520 Valley View Dr
Moline, IL 61265-6194
Phone (309) 762-3621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040407001036 IL Part B Supplier - Clinic/Group Practice 6406741784 Receives reassigned benefits from 123 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Geneseo, IL; Moline, IL; Rock Island, IL; Silvis, IL
O20100930010083 IL DME Supplier - Physician - Orthopedic/Orthopedic Surgery 6406741784 Practice locations: Geneseo, IL

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Moline Orthopedics Asso

Locations

1225 S Oakwood Ave
Ste 7B
Geneseo, IL 61254
Phone (309) 762-3621

Practitioners & affiliated clinicians

Practitioners 119

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 119

NPI Registry JSON

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1023089323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 VALLEY VIEW DR",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656194",
            "telephone_number": "309-762-3621",
            "fax_number": "309-762-3690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 S OAKWOOD AVE STE 7B",
            "city": "GENESEO",
            "state": "IL",
            "postal_code": "612541990",
            "telephone_number": "309-762-3621",
            "fax_number": "309-762-3690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORA ORTHOPEDICS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ORA ORTHOPEDICS, PC",
        "enumeration_date": "2006-01-27",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "BROCKMAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-322-0971"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "060006850",
            "primary": true
        },
        {
            "code": "246Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneseo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.