Active NPI
Pamela S. Vipond, APRN
- Nurse Practitioner
- Moline, IL
National Provider Identifier
1285739151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 041218923
- Practice address
- 400 John Deere Rd BLDG 1
Moline, IL 61265-6898 - Phone
- (309) 517-3036
- Fax
- (309) 797-1088
- NPI assigned
- Sep 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 041218923 | IL | Primary |
Addresses
Primary practice location
400 John Deere Rd BLDG 1
Moline, IL 61265-6898
Mailing address
400 John Deere Rd BLDG 1
Moline, IL 61265-6898
Phone (309) 517-3036
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0747303 | Medicaid | IA | |
| 041218923 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041218923 | IL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466640000000",
"number": "1285739151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 JOHN DEERE RD BLDG 1",
"city": "MOLINE",
"state": "IL",
"postal_code": "612656898",
"telephone_number": "309-517-3036",
"fax_number": "309-797-1088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 JOHN DEERE RD BLDG 1",
"city": "MOLINE",
"state": "IL",
"postal_code": "612656898",
"telephone_number": "309-517-3036",
"fax_number": "309-797-1088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIPOND",
"first_name": "PAMELA",
"middle_name": "S.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-14",
"last_updated": "2016-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "041218923",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0747303",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "041218923",
"state": "IL"
}
],
"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 Jun 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.