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RIVER VALLEY ORAL AND MAXILLOFACIAL SURGERY CLINIC LTD
NPI 1235250200
Dentist - Oral and Maxillofacial Surgery in Moline, IL

Active since April 03, 2007
930 16TH AVE, MOLINE, IL 61265(309) 797-1770(309) 797-1791 Get Directions Write a Review

NPPES record last updated: September 24, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 24, 2020, Aug 22, 2020 (2 updates tracked since 2020).

About River Valley Oral And Maxillofacial Surgery Clinic Ltd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RIVER VALLEY ORAL AND MAXILLOFACIAL SURGERY CLINIC LTD (NPI 1235250200) is a healthcare organization registered as an oral and maxillofacial surgery in Moline, Illinois and active in the NPI registry since April 2007. The organization lists Bradley J Lutchka, Oral Surgeon, as its authorized official.

NPPES Registry Identity

NPI1235250200
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameRIVER VALLEY ORAL AND MAXILLOFACIAL SURGERY CLINIC LTD
Location Address930 16TH AVEMoline, IL 61265
Mailing Address930 16th AveMoline, IL 61265 · (309) 797-1770 · Fax (309) 797-1791
Phone(309) 797-1770
Fax(309) 797-1791
Organization SubpartNo
Authorized OfficialBradley J LutchkaOral Surgeon · (309) 797-1770
Enumeration DateApril 3, 2007
Last NPPES UpdateSeptember 24, 20202 updates tracked since enumeration
NPPES CertifiedSeptember 24, 2020
✔ NPI 1235250200 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
930 16TH AVE, Moline, IL 61265
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

River Valley Oral And Maxillofacial Surgery Clinic Ltd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to River Valley Oral And Maxillofacial Surgery Clinic Ltd, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Bradley Lutchka
Maxillofacial Surgery
NPI 1780654202
930 16TH AVE
Moline, IL 61265
(309) 797-1770
✔ PECOS✔ Accepts MedicareSame address
Craig Thatcher
Maxillofacial Surgery
NPI 1013984541
930 16TH AVE
Moline, IL 61265
(309) 797-1720
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is River Valley Oral And Maxillofacial Surgery Clinic Ltd's NPI number?

The NPI number for River Valley Oral And Maxillofacial Surgery Clinic Ltd is 1235250200. It was assigned to this organization in the NPPES registry on April 3, 2007.

Where is River Valley Oral And Maxillofacial Surgery Clinic Ltd located?

River Valley Oral And Maxillofacial Surgery Clinic Ltd is located at 930 16th Ave, Moline, IL 61265. The listed phone number is (309) 797-1770.

What is River Valley Oral And Maxillofacial Surgery Clinic Ltd's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is River Valley Oral And Maxillofacial Surgery Clinic Ltd enrolled in Medicare?

Yes. River Valley Oral And Maxillofacial Surgery Clinic Ltd is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through River Valley Oral And Maxillofacial Surgery Clinic Ltd?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Maxillofacial Surgery, reassign their Medicare billing to River Valley Oral And Maxillofacial Surgery Clinic Ltd. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does River Valley Oral And Maxillofacial Surgery Clinic Ltd accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list River Valley Oral And Maxillofacial Surgery Clinic Ltd as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for River Valley Oral And Maxillofacial Surgery Clinic Ltd was last updated on September 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.