Individual provider Active NPI

Lydia Vannatta, PA-C

  • Physician Assistant
  • Rock Island, IL
National Provider Identifier
1801277850
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
078202 Issued in IA
Practice address
2701 17TH St
Rock Island, IL 61201-5351
Phone
(309) 779-5000
NPI assigned
Jun 16, 2015
Last updated
Jan 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 078202 IA Primary

Addresses

Primary practice location

2701 17TH St
Rock Island, IL 61201-5351

Mailing address

2701 17TH St
Rock Island, IL 61201-5351

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150807014169 IA Practitioner - Physician Assistant 1557675253 Reassigns benefits to 4 organizations
I20150909002820 IL Practitioner - Physician Assistant 1557675253 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

106 19TH Ave
Suite 103
Moline, IL 61265-3700
Phone (309) 779-7050

5185 Competition Dr
Bettendorf, IA 52722-8833
Phone (563) 888-5660

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
078202IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
The Finley Hospital Physician Assistant CurrentSince Jul 1, 2021 Accepting new patients
Iowa Physicians Clinic Medical Foundation CurrentSince Dec 1, 2025 Accepting new patients
Unity Healthcare CurrentSince Jun 12, 2018 Accepting new patients
Trinity Medical Center Physician Assistant CurrentSince Aug 3, 2015 Accepting new patients
Unity Healthcare Physician Assistant CurrentSince Jun 12, 2018 Accepting new patients
Advanced Radiology, S.C. PastSince Dec 1, 2025 Accepting new patients

Locations

3415 53rd Ave
Bettendorf, IA 52722
Phone (563) 742-4350

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

4500 Utica Ridge Rd
Bettendorf, IA 52722
Phone (563) 742-2724

5185 Competition Dr
Bettendorf, IA 52722
Phone (563) 888-5660

350 N Grandview Ave
Dubuque, IA 52001
Phone (563) 582-1881

1518 Mulberry Ave
Muscatine, IA 52761
Phone (563) 262-4110

600 N College Ave
Ste 120
Geneseo, IL 61254
Phone (309) 944-5342

106 19th Ave
Ste 103
Moline, IL 61265
Phone (309) 779-7050

3904 16th St
Ste C
Moline, IL 61265
Phone (309) 581-7610

500 John Deere Rd
Moline, IL 61265
Phone (309) 779-2840

2701 17th St
Rock Island, IL 61201
Phone (309) 779-3200

Interoperability endpoints

  • Direct secure messaging: lmadden268058@direct.unitypoint.org

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1801277850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 17TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 17TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015351",
            "telephone_number": "309-779-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANNATTA",
        "first_name": "LYDIA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-16",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "078202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Island, IL

Sources for this page

Verify at the official NPI Registry.