Active NPI
Kevin P Farrell, P.T.
- Physical Therapist
- Davenport, IA
National Provider Identifier
1598716987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 01349
- Practice address
- 1008 W 35TH St
Davenport, IA 52806-5827 - Phone
- (563) 324-2263
- Fax
- (563) 324-0719
- NPI assigned
- May 12, 2006
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 01349 | IA | Primary |
| Physical Therapist | 225100000X | 070-004837 | IL |
Addresses
Primary practice location
1008 W 35TH St
Davenport, IA 52806-5827
Mailing address
850 43Rd Ave Ste 100
Moline, IL 61265-8401
Phone (309) 743-2070
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01349 | Other | IA | IOWA PT LICENSE NO. |
| 070-004837 | Other | IL | ILLINOIS PT LICENSE NO. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01349 | IA | MD | Physical Therapist |
| 070-004837 | IL | MD | Physical Therapist |
Organizations & group practices 1
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.
-
- Surgery Physician
- Davenport, IA
- NPI 1528616901
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334102400000",
"number": "1598716987",
"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": "1008 W 35TH ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528065827",
"telephone_number": "563-324-2263",
"fax_number": "563-324-0719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARRELL",
"first_name": "KEVIN",
"middle_name": "P",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2012-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IA",
"license": "01349",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070-004837",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IOWA PT LICENSE NO.",
"identifier": "01349",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS PT LICENSE NO.",
"identifier": "070-004837",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.