Bradley J Lutchka

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Practice address

930 16TH Ave
Moline, IL 61265

Phone

(309) 797-1770

Fax

(309) 797-1791

NPI assigned

Jan 26, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

River Valley Oral and Maxillofacial Surgery Clinic LTDGroup PAC ID 0143310466, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• River Valley Oral and Maxillofacial Surgery Clinic LTD

  • Oral and Maxillofacial Surgery (Dentist)
  • Moline, IL
  • NPI 1235250200
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1780654202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 16TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "61265",
            "telephone_number": "309-797-1770",
            "fax_number": "309-797-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 16TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "61265",
            "telephone_number": "309-797-1770",
            "fax_number": "309-797-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTCHKA",
        "first_name": "BRADLEY",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2026-07-13",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott R Lopshire, D.D.S.
• Roger L Lubbers, MD
• Gary Brent Ludwig, PH.D
• Nicholas Scott Ludwig, M.D.
• Dave Curtis Lundberg
• Lutheran Social Services of Illinois (Intouch Home Care Services)
• Luxottica of America Inc. (Lenscrafters #470)
• Luxottica Retail North America Inc (Pearle Vision #C6309)
• Jeffrey John Lybarger, D.C.
• Sean P Lyons, OTRL

• Oral and Maxillofacial Surgery (Dentist) in Moline, IL
• Providers in Moline, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.