Stone Ridge Medical Group SC
NPI 1306097894ActiveOrganization· Family Medicine· East Moline, IL
Family Medicine in East Moline, Illinois, registered in NPPES in October 2008. The authorized official on file is James Petre, MD, President. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1306097894 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 2, 2008 |
| Last updated in NPPES | Oct 2, 2008 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | 336053231 | IL |
| Family Medicine | 207Q00000X | 036091695 | IL |
| Physician Assistant, Medical | 363AM0700X | 085002304 | IL |
| Nurse Practitioner | 363L00000X | 209000908 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL) |
|---|
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