Individual provider Active NPI

Aaron Clay Roby

  • Chiropractor
  • Swansea, IL
National Provider Identifier
1811205602
Registry record updated Sep 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.011690 Issued in IL
Practice address
4460 N Illinois St
Swansea, IL 62226-1899
Phone
(618) 926-2529
NPI assigned
Sep 15, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.011690 IL Primary

Addresses

Primary practice location

4460 N Illinois St
Swansea, IL 62226-1899

Mailing address

3225 Eldorado Blacktop Rd
Ridgway, IL 62979-2122
Phone (618) 926-2529

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170717002986 IL Practitioner - Chiropractic 1658641113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

633 Wesley Dr
Wood River, IL 62095-1970
Phone (618) 254-9355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038.011690ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Wood River Chiropractic, LLC Chiropractor CurrentSince Jun 19, 2017 Accepting new patients
Faccin Chiropractic, PC Chiropractor PastSince Jun 24, 2002 Accepting new patients

Locations

633 Wesley Dr
Wood River, IL 62095
Phone (618) 254-9355

203 S 6th St
Wood River, IL 62095
Phone (618) 254-9355

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284508800000",
    "number": "1811205602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 ELDORADO BLACKTOP RD",
            "city": "RIDGWAY",
            "state": "IL",
            "postal_code": "629792122",
            "telephone_number": "618-926-2529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4460 N ILLINOIS ST",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622261899",
            "telephone_number": "618-926-2529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBY",
        "first_name": "AARON",
        "middle_name": "CLAY",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-15",
        "last_updated": "2010-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.011690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansea, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; 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.