NPIMap

Organization Active NPI

Pediatric Group Associates, SC

  • Pediatrics Physician
  • Moline, IL
National Provider Identifier
1114987252
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC GROUP ASSOCIATES, SC
Practice address
1625 Avenue of the Cities
Moline, IL 61265-4856
Phone
(309) 797-5437
Fax
(309) 797-3140
NPI assigned
Mar 24, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Christy Weber
Title
Billing Supervisor
Phone
(309) 797-5437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X IL Primary

Addresses

Primary practice location

1625 Avenue of the Cities
Moline, IL 61265-4856

Mailing address

1625 Avenue of the Cities
Moline, IL 61265-4856
Phone (309) 797-5437

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0430761Pediatric Group Assoc1625 Avenue of the Cities, Moline, IL 61265AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

1625 Avenue of the Cities
Moline, IL 61265
Phone (309) 797-5437

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1114987252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 AVENUE OF THE CITIES",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654856",
            "telephone_number": "309-797-5437",
            "fax_number": "309-797-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 AVENUE OF THE CITIES",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654856",
            "telephone_number": "309-797-5437",
            "fax_number": "309-797-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC GROUP ASSOCIATES, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "WEBER",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "309-797-5437"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.