Individual provider Active NPI

Kevin A. Kelley, DPT

  • Physical Therapist
  • Moline, IL
National Provider Identifier
1508203936
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-019925 Issued in IL
Practice address
850 43Rd Ave Ste 300
Moline, IL 61265-8401
Phone
(309) 743-0300
NPI assigned
May 24, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070-019925 IL Primary
Physical Therapist 225100000X 1104573 KS

Addresses

Primary practice location

850 43Rd Ave Ste 300
Moline, IL 61265-8401

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, IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130807000362 IL Practitioner - Physical Therapist in Private Practice 6002058807 Reassigns benefits to 1 organization
I20130930000284 IA Practitioner - Physical Therapist in Private Practice 6002058807 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
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)

3385 Dexter CT
Suite 203
Davenport, IA 52807-3471
Phone (563) 332-9312

902 Illini Dr
Silvis, IL 61282-4700
Phone (309) 796-3450

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-019925ILMDPhysical Therapist
1104573KSMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Jun 23, 2013 Accepting new patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Jun 23, 2013 Accepting new patients

Locations

1705 N Ankeny Blvd
Ste A
Ankeny, IA 50023
Phone (515) 446-0733

1427 S Washington Blvd
Camanche, IA 52730
Phone (563) 259-4440

2635 Lincoln Way
Ste C
Clinton, IA 52732
Phone (563) 243-8321

3385 Dexter Ct
Ste 203
Davenport, IA 52807
Phone (563) 332-9312

1905 Ingersoll Ave
Ste 104
Des Moines, IA 50309
Phone (515) 369-2306

3414 Northport Dr
Ste 2
Muscatine, IA 52761
Phone (563) 263-2639

419 W Bridge Rd
Ste A
Polk City, IA 50226
Phone (515) 984-6377

5700 University Ave
Ste 222
West Des Moines, IA 50266
Phone (309) 743-2070

1225 S Oakwood Ave
Ste 1
Geneseo, IL 61254
Phone (309) 944-6447

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

850 43rd Ave
Ste 200
Moline, IL 61265
Phone (309) 743-0300

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

9901 N Knoxville Ave
Ste D
Peoria, IL 61615
Phone (309) 243-1989

9317A Il Route 84
Savanna, IL 61074
Phone (815) 273-2628

902 Illini Dr
Silvis, IL 61282
Phone (309) 796-3450

1013 N Cummings Ln
Washington, IL 61571
Phone (309) 444-1030

Organizations & group practices 2

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": "1369353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374019200000",
    "number": "1508203936",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 43RD AVE STE 300",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612658401",
            "telephone_number": "309-743-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "KEVIN",
        "middle_name": "A.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-24",
        "last_updated": "2013-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-019925",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "1104573",
            "primary": false
        }
    ],
    "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 Jul 17, 2013; 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.