NPIMap

Individual provider Active NPI

James E Petre, MD

  • Family Medicine Physician
  • East Moline, IL
National Provider Identifier
1619973989
Registry record updated Sep 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036091692 Issued in IL
Practice address
306 46TH Ave
East Moline, IL 61244-4281
Phone
(309) 796-2329
Fax
(309) 796-1146
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036091692 IL Primary

Addresses

Primary practice location

306 46TH Ave
East Moline, IL 61244-4281

Mailing address

865 Lincoln Rd
Ste L10
Bettendorf, IA 52722-4159
Phone (563) 355-9191

Other identifiers 6

IdentifierTypeStateIssuer
020356OtherHEALTH ALLIANCE
036091692MedicaidIL
20084OtherIOWA HEALTH SOLUTIONS
90722OtherWELLMARK BC/BS
0589291MedicaidIA
4796890020OtherDMERC

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
I20061003000456 IL Practitioner - Family Practice 2668477290 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Milan Medical Group, LTDGroup PAC ID 1951293562, 6 clinicians
Advanced Physical Therapy Services, LTD.Group PAC ID 9133101462, shared by 5 NPIs, 216 clinicians
Stone Ridge Medical Group SCGroup PAC ID 8729142534, 6 clinicians

Practice addresses (Care Compare)

1929 10TH Ave E
Milan, IL 61264-2953
Phone (309) 787-2600

300 Tenney St
Kewanee, IL 61443-3452
Phone (309) 853-5500

306 46TH Ave
East Moline, IL 61244-4281
Phone (309) 796-2329

Hospital & facility affiliations

  • Unity Point at Home Home health agency, Moline, IL, CCN 147009
  • Centerwell Home Health Home health agency, Moline, IL, CCN 147428
  • Mercyone Genesis Hospice, Bettendorf, IA, CCN 161520
  • Trinity Rock Island Hospital, Rock Island, IL, CCN 140280
  • Genesis HLTH System Dba Genesis MDL Ctr-Illini Hospital, Silvis, IL, CCN 140275
  • Trinity - Bettendorf Hospital, Bettendorf, IA, CCN 160104
  • Genesis Medical Center-Davenport Hospital, Davenport, IA, CCN 160033

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions24
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Stone Ridge Medical Group SC Family Medicine CurrentSince Dec 1, 2008 Accepting new patients
Milan Medical Group LTD CurrentSince Nov 1, 2023 Accepting new patients
Genesis Health System Past Accepting new patients
Genesis Health System Past Accepting new patients

Locations

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

1929 10th Ave E
Milan, IL 61264
Phone (309) 787-2600

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CAIFAA
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

Hospital & facility affiliations 7

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1619973989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 LINCOLN RD",
            "address_2": "STE L10",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224159",
            "telephone_number": "563-355-9191",
            "fax_number": "563-355-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 46TH AVE",
            "city": "EAST MOLINE",
            "state": "IL",
            "postal_code": "612444281",
            "telephone_number": "309-796-2329",
            "fax_number": "309-796-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRE",
        "first_name": "JAMES",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036091692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "020356",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036091692",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA HEALTH SOLUTIONS",
            "identifier": "20084",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BC/BS",
            "identifier": "90722",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0589291",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4796890020",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Moline, IL

Sources for this page

Verify at the official NPI Registry.