Ahuja Bariatric & Beyond
Organization Active NPI Surgery Physician · Mount Vernon, IL
NPI 1053043885 · NPPES record last updated Aug 2, 2022
Key facts
- NPI
- 1053043885
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- AHUJA BARIATRIC & BEYOND
- Practice address
- 4230 Lincolnshire Dr Ste a
Mount Vernon, IL 62864-2189 - Phone
- (618) 315-6466
- Fax
- (618) 315-6469
- NPI assigned
- Jun 29, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Naresh Ahuja, MD
- Title
- Member
- Phone
- (618) 242-2317
Practitioners 7
-
Issa Abedmahmoud, MD
-
Kerry Lynn Pitchford, APRN, FNP-BC
-
Poorva Talapatra, M.ED., LCPC
-
Autumn Corina Wills, P.A.
-
Syed Ahmed Shah, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220817001520 | IL | Part B Supplier - Clinic/Group Practice | 6901289347 |
Receives reassigned benefits from 6 practitioners Practice locations: Mount Vernon, IL; Marion, IL; Herrin, IL; Centralia, IL |
National Provider Directory
Locations
4501 W Deyoung St
Ste 108
Marion, IL 62959
4501 W Deyoung St
#108
Marion, IL 62959
4230 Lincolnshire Dr
Mount Vernon, IL 62864
Phone (618) 242-4205
4230 Lincolnshire Dr
New York, NY 10131
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | Yes |
Addresses
Primary practice location
4230 Lincolnshire Dr Ste a
Mount Vernon, IL 62864-2189
Mailing address
PO Box 675
Mount Vernon, IL 62864-0014
Phone (618) 242-2317
Other providers in Mount Vernon, IL
- Advanced Internal Medicine, LLC
- Advanced Surgical Technology, LLC
- Advanced Urologic Surgeons PC
- After Hours Immediate Care LLC
- Joon S Ahn
- Naresh Kumar Ahuja
- Reno Kumari Ahuja
- Air Evac EMS Inc
- Air Evac EMS, Inc.
- Iqbal M Akhter
All providers in Mount Vernon, IL · Surgery Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.