Individual provider Active NPI

Joaquin Ivan Pasquel Salcedo, PT

  • Physical Therapist
  • Edwardsville, IL
National Provider Identifier
1104702711
Registry record updated Jan 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2025050001 Issued in MO
Practice address
2133 S State Route 157
Edwardsville, IL 62025-3607
Phone
(618) 650-8337
NPI assigned
Aug 12, 2025
Last updated
Jan 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070.029269 IL
Physical Therapist 225100000X 2025050001 MO Primary

Addresses

Primary practice location

2133 S State Route 157
Edwardsville, IL 62025-3607

Mailing address

3016 HH Rd
Waterloo, IL 62298-5204
Phone (602) 754-9156

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260110000316 MO Practitioner - Physical Therapist in Private Practice 7012493943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

3518 Laclede Ave
Saint Louis, MO 63103-2011
Phone (314) 977-2323

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.029269ILMDPhysical Therapist
2025050001MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Jan 8, 2026 Accepting new patients
SSM Health Care Group CurrentSince Jan 8, 2026 Accepting new patients

Locations

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

3518 Laclede Ave
Saint Louis, MO 63103
Phone (314) 977-2323

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": "1754956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768262400000",
    "number": "1104702711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 HH RD",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622985204",
            "telephone_number": "602-754-9156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2133 S STATE ROUTE 157",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253607",
            "telephone_number": "618-650-8337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASQUEL SALCEDO",
        "first_name": "JOAQUIN",
        "middle_name": "IVAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-12",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.029269",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2025050001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2026; 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.