NPIMap

Organization Active NPI

Trinity Medical Center

Doing business as Trinity Work Fitness

  • General Practice Physician
  • Moline, IL
National Provider Identifier
1770699902
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
TRINITY MEDICAL CENTER
Doing business as
Trinity Work Fitness
Practice address
555 Valley View Dr
Moline, IL 61265-6138
Phone
(309) 764-9675
Fax
(309) 764-3106
NPI assigned
Aug 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jennifer L Everson, CPC
Title
Business Office Lead/Compliance Coo
Phone
(563) 742-5914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

555 Valley View Dr
Moline, IL 61265-6138

Mailing address

555 Valley View Dr
Moline, IL 61265-6138
Phone (309) 764-9675

Other names 1

  • Trinity Work Fitness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000016 IL Part B Supplier - Clinic/Group Practice 2264337518 Receives reassigned benefits from 177 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burr Ridge, IL; Rock Island, IL; Moline, IL; Geneseo, IL; Elmhurst, IL; East Moline, IL; Aledo, IL

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 10

Organizations listed as members of this organization in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770699902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 VALLEY VIEW DR",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656138",
            "telephone_number": "309-764-9675",
            "fax_number": "309-764-3106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 VALLEY VIEW DR",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656138",
            "telephone_number": "309-764-9675",
            "fax_number": "309-764-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EVERSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS OFFICE LEAD/COMPLIANCE COO",
        "authorized_official_telephone_number": "563-742-5914",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Work Fitness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 22, 2020; 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.

Verify at the official NPI Registry.