Active NPI
Quad City Prosthetic Inc
- Prosthetic/Orthotic Supplier
- Moline, IL
National Provider Identifier
1194058123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Legal business name
- QUAD CITY PROSTHETIC INC
- Practice address
- 520 Valley View Dr
Ste 500
Moline, IL 61265 - Phone
- (309) 762-6435
- Fax
- (309) 277-0042
- NPI assigned
- Sep 9, 2009
- Last updated
- Sep 24, 2024
- Organization subpart
- Yes
- Parent organization
- QUAD CITY PROSTHETIC INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Amit Bhanti, CPO
- Title
- Ceo
- Phone
- (309) 676-2276
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | NU | Primary |
Addresses
Primary practice location
520 Valley View Dr
Ste 500
Moline, IL 61265
Mailing address
741 W Main St
Peoria, IL 61606-1953
Phone (800) 334-5705
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service | Other | eSolutions Inc |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930071772 | IL | DME Supplier - Orthotic Personnel | 4082731120 | Practice locations: Moline, IL |
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| QCP Moline | Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Quad City Prosthetic Or
- Part of
- Quad City Prosthetic Or
Other organizations with this tax ID 5
Organizations that report the same tax identification number in the National Provider Directory.
-
- Prosthetic/Orthotic Supplier
- Rock Island, IL
- NPI 1215925805
-
- Prosthetic/Orthotic Supplier
- Freeport, IL
- NPI 1518198662
-
- Prosthetic/Orthotic Supplier
- Peru, IL
- NPI 1952634982
-
- Prosthetic/Orthotic Supplier
- Davenport, IA
- NPI 1578794624
-
- Prosthetic/Orthotic Supplier
- Des Moines, IA
- NPI 1932920071
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Comprehensive Prosthetics & Orthotics
- Prosthetic/Orthotic Supplier
- Quincy, IL
- NPI 1295062594
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252454400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1727136000000",
"number": "1194058123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "741 W MAIN ST",
"city": "PEORIA",
"state": "IL",
"postal_code": "616061953",
"telephone_number": "800-334-5705",
"fax_number": "888-663-6322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 VALLEY VIEW DR",
"address_2": "STE 500",
"city": "MOLINE",
"state": "IL",
"postal_code": "61265",
"telephone_number": "309-762-6435",
"fax_number": "309-277-0042"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "QUAD CITY PROSTHETIC INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "QUAD CITY PROSTHETIC INC",
"enumeration_date": "2009-09-09",
"last_updated": "2024-09-24",
"certification_date": "2024-09-24",
"status": "A",
"authorized_official_last_name": "BHANTI",
"authorized_official_first_name": "AMIT",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "309-676-2276",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CPO"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.1066.1",
"affiliationName": "eSolutions Inc",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CSV",
"address_1": "8215 W 108th Ter",
"city": "Overland Park",
"state": "KS",
"country_code": "US",
"postal_code": "662101661",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Sep 24, 2024; 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.