Active NPI
Ravindranath R Reddy, MD
- Pediatrics Physician
- Bloomingdale, IL
National Provider Identifier
1063587319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036051771
- Practice address
- 473 W Army Trail Road
#102
Bloomingdale, IL 60108 - Phone
- (630) 529-1000
- Fax
- (630) 529-7497
- NPI assigned
- Nov 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036051771 | IL | Primary |
| Pediatrics Physician | 208000000X | H0099 | TX |
Addresses
Primary practice location
473 W Army Trail Road
#102
Bloomingdale, IL 60108
Mailing address
473 W Army Trail Road
#102
Bloomingdale, IL 60108
Phone (630) 529-6969
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036051771 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036051771 | IL | MD | Pediatrics Physician |
| H0099 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| All Bear Cub Pediatrics, S.C. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Bloomingdale, IL
- NPI 1174681555
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369008000000",
"number": "1063587319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "473 W ARMY TRAIL ROAD",
"address_2": "#102",
"city": "BLOOMINGDALE",
"state": "IL",
"postal_code": "60108",
"telephone_number": "630-529-6969",
"fax_number": "630-529-7497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "473 W ARMY TRAIL ROAD",
"address_2": "#102",
"city": "BLOOMINGDALE",
"state": "IL",
"postal_code": "60108",
"telephone_number": "630-529-1000",
"fax_number": "630-529-7497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDDY",
"first_name": "RAVINDRANATH",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-22",
"last_updated": "2013-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036051771",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "H0099",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036051771",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bloomingdale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.