Individual provider Active NPI

John Randolph Lewis, M.D.

  • Cardiovascular Disease Physician
  • Davenport, IA
National Provider Identifier
1124007976
Registry record updated Nov 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
20857 Issued in IA
Practice address
1236 E Rusholme St
Suite 300
Davenport, IA 52803-2473
Phone
(563) 324-2992
Fax
(563) 888-0499
NPI assigned
Jan 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 20857 IA Primary

Addresses

Primary practice location

1236 E Rusholme St
Suite 300
Davenport, IA 52803-2473

Mailing address

1236 E Rusholme St
Suite 300
Davenport, IA 52803-2473
Phone (563) 324-2992

Other identifiers 1

IdentifierTypeStateIssuer
0156398MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiovascular Medicine PLLC Cardiovascular Disease CurrentSince Apr 1, 1997 Accepting new patients

Locations

1236 E Rusholme St
Ste 300
Davenport, IA 52803
Phone (319) 324-2992

1227 E Rusholme St
Davenport, IA 52803
Phone (563) 324-8160

350 John Deere Rd
Moline, IL 61265
Phone (309) 743-6700

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 1

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": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195603200000",
    "number": "1124007976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1236 E RUSHOLME ST",
            "address_2": "SUITE 300",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032473",
            "telephone_number": "563-324-2992",
            "fax_number": "563-888-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 E RUSHOLME ST",
            "address_2": "SUITE 300",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032473",
            "telephone_number": "563-324-2992",
            "fax_number": "563-888-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "JOHN",
        "middle_name": "RANDOLPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2007-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IA",
            "license": "20857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0156398",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.