STONE RIDGE MEDICAL GROUP SC - NPI 1306097894 - Family Medicine in East Moline, IL

Q: What is Stone Ridge Medical Group Sc's NPI number?

The NPI number for Stone Ridge Medical Group Sc is 1306097894. It was assigned to this organization in the NPPES registry on October 2, 2008.

Q: What is Stone Ridge Medical Group Sc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

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About Stone Ridge Medical Group Sc NPPES

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

STONE RIDGE MEDICAL GROUP SC (NPI 1306097894) is a healthcare organization registered as a family medicine in East Moline, Illinois and active in the NPI registry since October 2008. The organization holds a CLIA Microscopy certificate valid through May 27, 2028 and lists James Petre, President, as its authorized official.

NPPES Registry Identity

NPI1306097894

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameSTONE RIDGE MEDICAL GROUP SC

Location Address306 46TH AVEEast Moline, IL 61244-4281

Mailing Address306 46th AveEast Moline, IL 61244-4281 · (309) 796-2329 · Fax (309) 796-1146

Phone(309) 796-2329

Fax(309) 796-1146

Organization SubpartNo

Authorized OfficialJames PetrePresident · (309) 796-2329

Enumeration DateOctober 2, 2008

✔ NPI 1306097894 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in IL · 336053231✔ Licensed in IL · 036091695

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X · License 085002304 (IL)

Also ListedNurse PractitionerTaxonomy 363L00000X · License 209000908 (IL)

306 46TH AVE, East Moline, IL 61244

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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 MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 14D0946584

Stone Ridge Medical Group · East Moline, IL

Active · expires May 27, 2028

CLIA Number14D0946584

Laboratory TypePhysician Office

Certificate Effective DateMay 28, 2026

Certificate Expiration DateMay 27, 2028

Laboratory DirectorJames E. Petre MD

Laboratory Phone(309) 796-2329

Laboratory LocationStone Ridge Medical Group306 46th Ave, East Moline, IL 61244

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GENESIS HEALTH SYSTEM

Family Medicine