Active NPI
Melvin J. Richards, M.D.
- Diagnostic Radiology Physician
- Moline, IL
National Provider Identifier
1508866351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 17497
- Practice address
- 615 Valley View Dr.
Suite 202
Moline, IL 61265-6180 - Phone
- (309) 762-1072
- Fax
- (309) 762-1094
- NPI assigned
- Jul 22, 2005
- Last updated
- Jul 16, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 036-045892 | IL | |
| Diagnostic Radiology Physician | 2085R0202X | 17497 | IA | Primary |
Addresses
Primary practice location
615 Valley View Dr.
Suite 202
Moline, IL 61265-6180
Mailing address
615 Valley View Dr.
Suite 202
Moline, IL 61265-6180
Phone (309) 762-1072
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8916924 | Medicaid | IA | |
| 0576694 | Medicaid | IA | |
| 3576694 | Medicaid | IA | |
| 1576694 | Medicaid | IA | |
| 97671 | Other | IL | WELLMARK |
| 036045892 | Medicaid | IL | |
| 20144 | Other | IA | IA HEALTH SOLUTIONS |
| 95101 | Other | IL | WELLMARK |
| 47823 | Other | IA | WELLMARK |
| 5916924 | Medicaid | IA | |
| 9916924 | Medicaid | IA | |
| 4916924 | Medicaid | IA | |
| 2576694 | Medicaid | IA | |
| 7916924 | Medicaid | IA |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-045892 | IL | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ora Orthopedics, PC | Past | Accepting new patients | |
| Advanced Radiology, S.C. | Diagnostic Radiology | Past | Accepting new patients |
| Ora Orthopedics PC | Past | Accepting new patients |
Organizations & group practices 3
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279238400000",
"number": "1508866351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 VALLEY VIEW DR.",
"address_2": "SUITE 202",
"city": "MOLINE",
"state": "IL",
"postal_code": "612656180",
"telephone_number": "309-762-1072",
"fax_number": "309-762-1094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 VALLEY VIEW DR.",
"address_2": "SUITE 202",
"city": "MOLINE",
"state": "IL",
"postal_code": "612656180",
"telephone_number": "309-762-1072",
"fax_number": "309-762-1094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDS",
"first_name": "MELVIN",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-22",
"last_updated": "2010-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IL",
"license": "036-045892",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IA",
"license": "17497",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8916924",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0576694",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3576694",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1576694",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK",
"identifier": "97671",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036045892",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IA HEALTH SOLUTIONS",
"identifier": "20144",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK",
"identifier": "95101",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK",
"identifier": "47823",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5916924",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9916924",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4916924",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2576694",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7916924",
"state": "IA"
}
],
"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 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.