Individual provider Active NPI

Pramod Mallipaddi, MD

  • Pediatrics Physician
  • Urbana, IL
National Provider Identifier
1083817886
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036147159 Issued in IL
Practice address
611 W Park St
Urbana, IL 61801-2529
Phone
(217) 383-3311
NPI assigned
Jun 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036147159 IL Primary
Pediatrics Physician 208000000X 11730 ND
Pediatrics Physician 208000000X 4301085525 MI
Neonatal-Perinatal Medicine Physician 2080N0001X 036147159 IL

Addresses

Primary practice location

611 W Park St
Urbana, IL 61801-2529

Mailing address

611 W Park St
Urbana, IL 61801-2501

Other practice location 1

1304 Franklin Ave
Normal, IL 61761-3558
Phone (309) 454-1400

Other practice location 2

1000 South Columbia Road
Grand Forks, ND 58206-6002
Phone (701) 780-5000

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
I20181219000000 IL Practitioner - Pediatric MedicinePractitioner - Other (Physician) 4486821295 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301085525MIMDPediatrics Physician
036147159ILMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Richland Memorial Hospital, Inc. CurrentSince Dec 10, 2020 Accepting new patients
Carle Health Care Incorporated CurrentSince Nov 4, 2018 Accepting new patients
Richland Memorial Hospital, Inc Current Accepting new patients
Hoopeston Community Memorial Hospital CurrentSince Oct 2, 2023 Accepting new patients
Hoopeston Community Memorial Hospital Current Accepting new patients
Richland Memorial Hospital, Inc CurrentSince Dec 10, 2020 Accepting new patients
Hoopeston Community Memorial Hospital Current Accepting new patients
Carle West Physician Group Inc CurrentSince Feb 1, 2021 Accepting new patients
Carle Health Care Incorporated Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

3310 Fields South Dr
Champaign, IL 61822
Phone (217) 417-2352

701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531

1304 Franklin Ave
Normal, IL 61761
Phone (309) 268-3590

900 E Scott St
Olney, IL 62450
Phone (618) 345-1000

1201 Ricker Rd
Salem, IL 62881
Phone (618) 548-3194

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: pmallipaddimd263288@carlehiedirect.net

Organizations & group practices 10

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1083817886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529",
            "telephone_number": "217-383-3311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1304 Franklin Ave",
            "address_purpose": "LOCATION",
            "city": "Normal",
            "state": "IL",
            "postal_code": "617613558",
            "country_code": "US",
            "telephone_number": "309-454-1400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 South Columbia Road",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582066002",
            "country_code": "US",
            "telephone_number": "701-780-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLIPADDI",
        "first_name": "PRAMOD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036147159",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ND",
            "license": "11730",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301085525",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036147159",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.