NPIMap

Organization Active NPI

Ideal Health and Wellness, SC

Doing business as Ideal Health and Wellness, SC, Corp

  • Family Medicine Physician
  • Davenport, IA
National Provider Identifier
1689013393
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
IDEAL HEALTH AND WELLNESS, SC
Doing business as
Ideal Health and Wellness, SC, Corp
Practice address
1850 E 53Rd St Ste 2
Davenport, IA 52807-2784
Phone
(563) 359-4106
Fax
(563) 359-4130
NPI assigned
Jun 17, 2013
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Kathryn Frega, D.C., N.D.NPI 1790067783
Title
Owner/Doctor
Phone
(563) 359-4106

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 083863 IA
Chiropractor 111N00000X NU
Internist Chiropractor 111NI0900X 038012020 IL
Acupuncturist 171100000X NU
Naturopath 175F00000X NU
Family Medicine Physician 207Q00000X NU Primary
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

1850 E 53Rd St Ste 2
Davenport, IA 52807-2784

Mailing address

1850 E 53Rd St Ste 2
Davenport, IA 52807-2784
Phone (563) 359-4106

Other practice location 1

3900 28th Avenue Dr
Suite 125
Moline, IL 61265-5536
Phone (309) 281-6230

Other names 1

  • Ideal Health and Wellness, SC, Corp Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171017001879 IA Part B Supplier - Clinic/Group Practice 1658597919 Receives reassigned benefits from 2 practitioners
Practice locations: Davenport, IA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2276181Ideal Health and Wellness1850 E 53Rd St Suite 2, Davenport, IA 52807Certificate of waiverFeb 2, 2027

National Provider Directory

National Provider Directory

Locations

1850 E 53rd St
Ste 2
Davenport, IA 52807
Phone (563) 359-1985

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1689013393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 E 53RD ST STE 2",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072784",
            "telephone_number": "563-359-4106",
            "fax_number": "563-359-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 E 53RD ST STE 2",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072784",
            "telephone_number": "563-359-4106",
            "fax_number": "563-359-4130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 28th Avenue Dr",
            "address_2": "Suite 125",
            "address_purpose": "LOCATION",
            "city": "Moline",
            "state": "IL",
            "postal_code": "612655536",
            "country_code": "US",
            "telephone_number": "309-281-6230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IDEAL HEALTH AND WELLNESS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-17",
        "last_updated": "2022-07-21",
        "certification_date": "2020-03-30",
        "status": "A",
        "authorized_official_last_name": "FREGA",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "563-359-4106",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C., N.D."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "083863",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "111NI0900X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Internist",
            "state": "IL",
            "license": "038012020",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ideal Health and Wellness, SC, Corp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 21, 2022; 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.