Active NPI
Joanne Ruth Nelson, M.AUD. CCC-A
- Audiologist
- East Moline, IL
National Provider Identifier
1669718912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 147000591
- Practice address
- 4670 11TH St
East Moline, IL 61244-4428 - Phone
- (309) 796-2500
- Fax
- (309) 796-2911
- NPI assigned
- Dec 13, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 147000591 | IL | Primary |
Addresses
Primary practice location
4670 11TH St
East Moline, IL 61244-4428
Mailing address
4670 11TH St
East Moline, IL 61244-4428
Phone (309) 796-2500
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 147000591 | IL | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blackhawk Area SP Ed Dist 865 | Past | Accepting new patients |
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.
-
- Local Education Agency (LEA)
- East Moline, IL
- NPI 1992907455
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355356800000",
"number": "1669718912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4670 11TH ST",
"city": "EAST MOLINE",
"state": "IL",
"postal_code": "612444428",
"telephone_number": "309-796-2500",
"fax_number": "309-796-2511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4670 11TH ST",
"city": "EAST MOLINE",
"state": "IL",
"postal_code": "612444428",
"telephone_number": "309-796-2500",
"fax_number": "309-796-2911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "JOANNE",
"middle_name": "RUTH",
"name_prefix": "Miss",
"credential": "M.AUD. CCC-A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-13",
"last_updated": "2012-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "IL",
"license": "147000591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Moline, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.