Individual provider Active NPI

Jordan R Deneve, DPT

  • Physical Therapist
  • Bettendorf, IA
National Provider Identifier
1194140244
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
072794 Issued in IA
Practice address
2300 53Rd Ave Ste LL02
Bettendorf, IA 52722-7565
Phone
(563) 449-7000
NPI assigned
Feb 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070020563 IL
Physical Therapist 225100000X 072794 IA Primary

Addresses

Primary practice location

2300 53Rd Ave Ste LL02
Bettendorf, IA 52722-7565

Mailing address

850 43Rd Ave Ste 100
Moline, IL 61265-8401
Phone (309) 743-2070

Other identifiers 1

IdentifierTypeStateIssuer
072794OtherIAPT LICENSE

Other names 1

  • Jordan R Galles Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140312000578 IL Practitioner - Physical Therapist in Private Practice 2769612852 Reassigns benefits to 2 organizations
I20140922001577 IA Practitioner - Physical Therapist in Private Practice 2769612852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rock Valley Physical Therapy CenterGroup PAC ID 9638087877, 232 clinicians

Practice addresses (Care Compare)

3385 Dexter CT
Suite 203
Davenport, IA 52807-3471
Phone (563) 332-9312

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
072794IAMDPhysical Therapist
070020563ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Feb 3, 2014 Accepting new patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Feb 3, 2014 Accepting new patients
Ora Orthopedics, PC Past Accepting new patients

Locations

931 13th Ave N
Clinton, IA 52732
Phone (563) 242-2305

3385 Dexter Ct
Ste 203
Davenport, IA 52807
Phone (563) 332-9312

520 Valley View Dr
Moline, IL 61265
Phone (309) 762-1952

850 43rd Ave
Ste 100
Moline, IL 61265
Phone (309) 743-2070

850 43rd Ave
Ste 300
Moline, IL 61265
Phone (309) 743-0300

Organizations & group practices 4

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": "1393372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1194140244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 43RD AVE STE 100",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612658401",
            "telephone_number": "309-743-2070",
            "fax_number": "309-743-2073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 53RD AVE STE LL02",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527227565",
            "telephone_number": "563-449-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENEVE",
        "first_name": "JORDAN",
        "middle_name": "R",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-26",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070020563",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "072794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "072794",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "GALLES",
            "middle_name": "R",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bettendorf, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.

Verify at the official NPI Registry.