Individual provider Active NPI

Michelle Snodgrass, DPT

  • Physical Therapist
  • Moline, IL
National Provider Identifier
1023554706
Registry record updated Dec 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
850 43Rd Ave
Suite 100
Moline, IL 61265-8401
Phone
(309) 743-2070
Fax
(309) 743-2073
NPI assigned
Jan 18, 2017
Last updated
Dec 6, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

850 43Rd Ave
Suite 100
Moline, IL 61265-8401

Mailing address

850 43Rd Ave
Suite 100
Moline, IL 61265-8401
Phone (309) 743-2070

Other identifiers 1

IdentifierTypeStateIssuer
070022843OtherIALICENSE

Other names 1

  • Michelle McConnell Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170324000970 IL Practitioner - Physical Therapist in Private Practice 3870878382 Reassigns benefits to 1 organization
I20180614002715 IA Practitioner - Physical Therapist in Private Practice 3870878382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1700 N Division St
Suite 200
Davenport, IA 52804-3535
Phone (563) 324-2263

850 43Rd Ave
Suite 300
Moline, IL 61265-8401
Phone (309) 743-0300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Jan 30, 2017 Accepting new patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Jan 30, 2017 Accepting new patients

Locations

1700 N Division St
Ste 200
Davenport, IA 52804
Phone (563) 324-2263

850 43rd Ave
Ste 100
Moline, IL 61265
Phone (309) 743-2070

850 43rd Ave
Ste 300
Moline, IL 61265
Phone (309) 743-0300

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512518400000",
    "number": "1023554706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 43RD AVE",
            "address_2": "SUITE 100",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612658401",
            "telephone_number": "309-743-2070",
            "fax_number": "309-743-2073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 43RD AVE",
            "address_2": "SUITE 100",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612658401",
            "telephone_number": "309-743-2070",
            "fax_number": "309-743-2073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNODGRASS",
        "first_name": "MICHELLE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-18",
        "last_updated": "2017-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "070022843",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "MCCONNELL",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Moline, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.