Individual provider Active NPI

Sachin S Nunnewar, MD

  • Pediatrics Physician
  • Moline, IL
National Provider Identifier
1114161908
Registry record updated May 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
38205 Issued in IA
Practice address
1106 4TH Ave
Moline, IL 61265-1231
Phone
(563) 327-2000
Fax
(563) 327-2045
NPI assigned
Apr 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 38205 IA Primary

Addresses

Primary practice location

1106 4TH Ave
Moline, IL 61265-1231

Mailing address

1106 4TH Ave
Moline, IL 61265-1231
Phone (563) 327-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090814000414 IL Practitioner - Pediatric Medicine 1850445578 Reassigns benefits to 1 organization
I20131206000822 IA Practitioner - Pediatric Medicine 1850445578 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
38205IAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke'S Methodist Hospital CurrentSince Jan 1, 2015 Accepting new patients
St Luke'S Methodist Hospital CurrentSince Jan 1, 2015 Accepting new patients
Iowa Physicians Clinic Medical Foundation Pediatrics CurrentSince Feb 21, 2014 Accepting new patients
Trinity Medical Center Past Accepting new patients
Iowa Physicians Clinic Medical Foundation Past Accepting new patients

Locations

3415 53rd Ave
Bettendorf, IA 52722
Phone (563) 742-4350

4480 Utica Ridge Rd
Ste 1120
Bettendorf, IA 52722
Phone (563) 742-5750

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

1026 A Ave NE
Cedar Rapids, IA 52402
Phone (319) 369-5970

202 10th St SE
Ste 285
Cedar Rapids, IA 52403
Phone (319) 369-7816

1001 Pennsylvania Ave
Ottumwa, IA 52501
Phone (641) 472-4111

600 N College Ave
Ste 120
Geneseo, IL 61254
Phone (309) 944-5342

Interoperability endpoints

  • Direct secure messaging: snunnewar92402@direct.unitypoint.org

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": "1240531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399420800000",
    "number": "1114161908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 4TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612651231",
            "telephone_number": "563-327-2000",
            "fax_number": "563-327-2045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 4TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612651231",
            "telephone_number": "563-327-2000",
            "fax_number": "563-327-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUNNEWAR",
        "first_name": "SACHIN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-24",
        "last_updated": "2014-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "38205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

Verify at the official NPI Registry.