Individual provider Active NPI

Samuel Long

  • Physical Therapist
  • Moline, IL
National Provider Identifier
1205588472
Registry record updated Jan 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
510 Valley View Dr
Moline, IL 61265-6133
Phone
(309) 797-0866
Fax
(309) 797-0872
NPI assigned
Jan 19, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

510 Valley View Dr
Moline, IL 61265-6133

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220317001608 IL Practitioner - Physical Therapist in Private Practice 3476948076 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3800 Ave of the Cities
Suite 107
Moline, IL 61265-4424
Phone (309) 743-0106

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Mar 7, 2022 Accepting new patients
Ora Orthopedics, PC CurrentSince Mar 7, 2022 Accepting new patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Mar 7, 2022 Accepting new patients
Ora Orthopedics PC CurrentSince Mar 7, 2022 Accepting new patients

Locations

2300 53rd Ave
Ste LL04
Bettendorf, IA 52722

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

3800 Avenue of the Cities
Ste 107
Moline, IL 61265
Phone (309) 743-0106

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

510 Valley View Dr
Moline, IL 61265
Phone (309) 762-3621

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

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": "1642550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1205588472",
    "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": "309-743-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 VALLEY VIEW DR",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656133",
            "telephone_number": "309-797-0866",
            "fax_number": "309-797-0872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "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 Jan 19, 2022; 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.