Individual provider Active NPI

Melissa Kae Birdsell, D.C.

  • Chiropractor
  • Moline, IL
National Provider Identifier
1265721989
Registry record updated Apr 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.011912 Issued in IL
Practice address
1201 5TH Ave
Moline, IL 61265-1331
Phone
(309) 764-8821
Fax
(309) 757-4773
NPI assigned
Apr 4, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.011912 IL Primary

Addresses

Primary practice location

1201 5TH Ave
Moline, IL 61265-1331

Mailing address

1201 5TH Ave
Moline, IL 61265-1331
Phone (309) 764-8821

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111010000043 IL Practitioner - Chiropractic 2466624713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2011
Medicare assignment
May accept Medicare assignment
Group practices
Birdsell Chiropractic and Acupuncture Clinic, CharteredGroup PAC ID 3476641606, 3 clinicians

Practice addresses (Care Compare)

1201 5TH Ave
Moline, IL 61265-1331
Phone 30976488212

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038.011912ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Birdsell Chiropractic & Acupuncture Clinic, Chartered Chiropractor CurrentSince Sep 27, 2011 Accepting new patients

Locations

1201 5th Ave
Moline, IL 61265
Phone (309) 764-8821

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": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301875200000",
    "number": "1265721989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612651331",
            "telephone_number": "309-764-8821",
            "fax_number": "309-757-4773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612651331",
            "telephone_number": "309-764-8821",
            "fax_number": "309-757-4773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRDSELL",
        "first_name": "MELISSA",
        "middle_name": "KAE",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-04",
        "last_updated": "2011-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.011912",
            "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 Apr 4, 2011; 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.