Individual provider Active NPI

Patricia I. Ittmann, DO

  • Neonatal-Perinatal Medicine Physician
  • Rockford, IL
National Provider Identifier
1124138318
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
036-088059 Issued in IL
Practice address
2400 N Rockton Ave
Rockford, IL 61103-3655
Phone
(815) 971-2000
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 036-088059 IL Primary

Addresses

Primary practice location

2400 N Rockton Ave
Rockford, IL 61103-3655

Mailing address

2400 N Rockton Ave
Rockford, IL 61103-3655
Phone (815) 971-2000

Other practice location 1

1401 E State St
Rockford, IL 61104-2315
Phone (779) 696-7400

Other identifiers 1

IdentifierTypeStateIssuer
036088059MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pittmann1064799@direct.uwhealth.org

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)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036-088059ILMDNeonatal-Perinatal Medicine Physician

Interoperability endpoints

  • Direct secure messaging: pittmann1064799@direct.uwhealth.org
  • Direct secure messaging: pittmann273454@ahs.direct-ci.com

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1124138318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 N ROCKTON AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033655",
            "telephone_number": "815-971-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N ROCKTON AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033655",
            "telephone_number": "815-971-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 E State St",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611042315",
            "country_code": "US",
            "telephone_number": "779-696-7400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ITTMANN",
        "first_name": "PATRICIA",
        "middle_name": "I.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036-088059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036088059",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pittmann1064799@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "1401 E State St",
            "city": "Rockford",
            "state": "IL",
            "country_code": "US",
            "postal_code": "611042315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.