NPIMap

Individual provider Active NPI

Thomas Robert Staley, MD

  • Family Medicine Physician
  • Davenport, IA
National Provider Identifier
1174750855
Registry record updated Jun 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R8645 Issued in IA
Practice address
1345 W Central Park Ave
Davenport, IA 52804-1844
Phone
(563) 421-4400
Fax
(563) 421-4449
NPI assigned
Jun 19, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R8645 IA Primary

Addresses

Primary practice location

1345 W Central Park Ave
Davenport, IA 52804-1844

Mailing address

1345 W Central Park Ave
Davenport, IA 52804-1844
Phone (563) 421-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101206000930 IA Practitioner - Family Practice 3971790775 Reassigns benefits to 2 organizations
I20180411000191 IL Practitioner - Family Practice 3971790775 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iowa Physicians Clinic Medical Foundation 1,254 clinicians

Practice addresses (Care Compare)

1518 Mulberry Ave
Muscatine, IA 52761-3433
Phone (563) 262-4115

600 N College Ave
Suite 120
Geneseo, IL 61254-1095
Phone (309) 944-5342

Hospital & facility affiliations

  • Unity Point at Home Home health agency, Moline, IL, CCN 147009
  • Heartland Hospice Davenport Hospice, Davenport, IA, CCN 161568
  • Hospice Compassus - Northwest Illinois Hospice, Galesburg, IL, CCN 141581
  • Unitypoint Hospice Hospice, Moline, IL, CCN 141583
  • Mercyone Genesis Hospice, Bettendorf, IA, CCN 161520
  • St Croix Hospice Hospice, Moline, IL, CCN 141747
  • Hammond Henry Hospital Hospital, Geneseo, IL, CCN 141319
  • Trinity Rock Island Hospital, Rock Island, IL, CCN 140280
  • Trinity - Bettendorf Hospital, Bettendorf, IA, CCN 160104
  • Kahl Home for the Aged & Infirmed Nursing home, Davenport, IA, CCN 165146
  • Harmony Utica Ridge Nursing home, Davenport, IA, CCN 165575
  • Friendship Manor Nursing home, Rock Island, IL, CCN 146099
  • Allure of Geneseo Nursing home, Geneseo, IL, CCN 145789
  • The Vistas at Bettendorf Nursing home, Bettendorf, IA, CCN 165553

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R8645IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Physicians Clinic Medical Foundation Family Medicine CurrentSince Apr 23, 2018 Accepting new patients
Trinity Medical Center Current Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Trinity Medical Center Family Medicine CurrentSince Feb 26, 2018 Accepting new patients
Iowa Physicians Clinic Medical Foundation Family Medicine CurrentSince Mar 21, 2018 Accepting new patients
Genesis Health System Family Medicine Past Accepting new patients
Hillcrest Home Past Accepting new patients
Genesis Medical Education Foundation Inc Family Medicine Past Accepting new patients
Kahl Home for the Aged & Infirm PastSince Feb 10, 2025 Accepting new patients

Locations

4500 Utica Ridge Rd
Bettendorf, IA 52722
Phone (563) 742-2724

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

6701 Jersey Ridge Rd
Davenport, IA 52807
Phone (563) 324-1621

1518 Mulberry Ave
Muscatine, IA 52761
Phone (563) 262-4110

8101 Birchwood Ct
Unit R
Urbandale, IA 50131
Phone (515) 471-9363

14688 Illinois Highway 82
Geneseo, IL 61254
Phone (309) 944-2147

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

500 John Deere Rd
Moline, IL 61265
Phone (309) 779-2840

2701 17th St
Rock Island, IL 61201
Phone (309) 779-3200

Interoperability endpoints

  • Direct secure messaging: tstaley608043@direct.unitypoint.org

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Friendship ManorRock Island, IL, CCN 146099 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2019
May 1, 2019
Hammond Henry Hospital Skilled Nursing FacilityGeneseo, IL, CCN 145464 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 21, 2025
Jan 21, 2025
Kahl Home for the Aged & InfirmDavenport, IA, CCN 165146 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 10, 2025
Feb 10, 2025
Hillcrest HomeGeneseo, IL, CCN 145949 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 11, 2018
Apr 11, 2018
The Vistas at BettendorfBettendorf, IA, CCN 165553 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2023
Jan 1, 2023
Heartland Hospice (Davenport)Davenport, IA, CCN 161568 Hospice Contracted Managing Employee Nov 1, 2023

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 10

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245369600000",
    "number": "1174750855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 W CENTRAL PARK AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528041844",
            "telephone_number": "563-421-4400",
            "fax_number": "563-421-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 W CENTRAL PARK AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528041844",
            "telephone_number": "563-421-4400",
            "fax_number": "563-421-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALEY",
        "first_name": "THOMAS",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-19",
        "last_updated": "2009-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R8645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.