NPIMap

Individual provider Active NPI

Jean E Wardlow, MD

  • Internal Medicine Physician
  • Moline, IL
National Provider Identifier
1316984313
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036115384 Issued in IL
Practice address
3900 28TH Avenue Dr
Moline, IL 61265-5536
Phone
(309) 281-2900
Fax
(309) 281-6009
NPI assigned
May 31, 2006
Last updated
Jul 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036115384 IL Primary

Addresses

Primary practice location

3900 28TH Avenue Dr
Moline, IL 61265-5536

Mailing address

3900 28TH Avenue Dr
Moline, IL 61265-5536
Phone (309) 281-2900

Other identifiers 1

IdentifierTypeStateIssuer
036115384MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jean.wardlow@direct.genesishealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060727000312 IL Practitioner - Internal Medicine 3870506488 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Health SystemGroup PAC ID 7214841436, 217 clinicians
Quad City Physical Therapy and SpineGroup PAC ID 1850332651, 29 clinicians

Practice addresses (Care Compare)

202 Picard St
Alpha, IL 61413-5023
Phone (309) 629-4601

5254 Utica Ridge Rd
Davenport, IA 52807-3872
Phone (563) 359-3799

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036115384ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health System Internal Medicine CurrentSince Dec 1, 2008 Accepting new patients
Genesis Health System CurrentSince Dec 1, 2008 Accepting new patients
Genesis Health System Past Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients
Genesis Health System Past Accepting new patients
Genesis Health System Internal Medicine PastSince Aug 4, 2025 Accepting new patients

Locations

1227 E Rusholme St
Davenport, IA 52803
Phone (563) 324-8160

1351 W Central Park Ave
Ste 340
Davenport, IA 52804
Phone (563) 421-1287

202 Picard St
Alpha, IL 61413
Phone (309) 629-4601

306 46th Ave
East Moline, IL 61244
Phone (309) 796-2329

Interoperability endpoints

  • Direct secure messaging: jean.wardlow@direct.genesishealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1316984313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 28TH AVENUE DR",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612655536",
            "telephone_number": "309-281-2900",
            "fax_number": "309-281-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 28TH AVENUE DR",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612655536",
            "telephone_number": "309-281-2900",
            "fax_number": "309-281-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARDLOW",
        "first_name": "JEAN",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-31",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036115384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036115384",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jean.wardlow@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3900 28th Avenue Dr",
            "city": "Moline",
            "state": "IL",
            "country_code": "US",
            "postal_code": "612655536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

Verify at the official NPI Registry.