Individual provider Active NPI

Clementina Asamoah, MD

  • Obstetrics & Gynecology Physician
  • Bourbonnais, IL
National Provider Identifier
1043830698
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036169741 Issued in IL
Practice address
338 Larry Power Rd
Bourbonnais, IL 60914-4430
Phone
(815) 935-4651
NPI assigned
Apr 23, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036169741 IL Primary

Addresses

Primary practice location

338 Larry Power Rd
Bourbonnais, IL 60914-4430

Mailing address

338 Larry Power Rd
Bourbonnais, IL 60914-4430
Phone (815) 935-4651

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240617000459 IL Practitioner - Obstetrics/Gynecology 8224459482 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

105 S 1St St
Willmington, IL 60481-8973
Phone (815) 476-5210

338 Larry Power Rd
Bourbonnais, IL 60914-4430
Phone (815) 935-2991

350 N Wall St 4TH Floor
Kankakee, IL 60901-2901
Phone 81593316714592

375 N Wall St
P520
Kankakee, IL 60901-3493
Phone (815) 933-0194

Hospital & facility affiliations

  • Riverside Medical Center Hospital, Kankakee, IL, CCN 140186

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Jun 4, 2024 Accepting new patients
Riverside Health System Current Accepting new patients
University Physician Group PastSince Apr 1, 2020 Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

338 Larry Power Rd
Bourbonnais, IL 60914
Phone (815) 935-2991

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Interoperability endpoints

  • Direct secure messaging: casamoah50357@direct.riversidehealthcare.net

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1587600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1043830698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 LARRY POWER RD",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144430",
            "telephone_number": "815-935-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 LARRY POWER RD",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144430",
            "telephone_number": "815-935-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASAMOAH",
        "first_name": "CLEMENTINA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-23",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036169741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

Verify at the official NPI Registry.