Individual provider Active NPI

Matthew J Moore, P.T.

  • Physical Therapist
  • Moline, IL
National Provider Identifier
1376590836
Registry record updated Apr 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-012189 Issued in IL
Practice address
520 Valley View Dr Ste 200
Moline, IL 61265-6152
Phone
(309) 797-0866
Fax
(309) 797-0872
NPI assigned
May 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2012

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 070-012189 IL Primary

Addresses

Primary practice location

520 Valley View Dr Ste 200
Moline, IL 61265-6152

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
070-012189OtherILILLINOIS PT LICENSE NO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040723001195 IL Practitioner - Physical Therapist in Private Practice 4587644075 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
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)

850 43Rd Ave
Suite 300
Moline, IL 61265-8401
Phone (309) 743-0300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-012189ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ora Orthopedics, PC CurrentSince Oct 1, 2018 Accepting new patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Mar 22, 2004 Accepting new patients
Ora Orthopedics PC CurrentSince Oct 1, 2018 Accepting new patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Mar 22, 2004 Accepting new patients

Locations

2300 53rd Ave
Ste LL04
Bettendorf, IA 52722

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

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

520 Valley View Dr
Ste 200
Moline, IL 61265
Phone (309) 797-0866

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334188800000",
    "number": "1376590836",
    "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": "520 VALLEY VIEW DR STE 200",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656152",
            "telephone_number": "309-797-0866",
            "fax_number": "309-797-0872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2012-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-012189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS PT LICENSE NO",
            "identifier": "070-012189",
            "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 Apr 12, 2012; 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.