Individual provider Active NPI

Ankita Chowdary Nekkanti, M.B.B.S.,

  • Gastroenterology Physician
  • Peoria, IL
National Provider Identifier
1154065605
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036.173749 Issued in IL
Practice address
530 N.E. Glen Oak Ave
Peoria, IL 61637
Phone
(309) 655-6384
Fax
(309) 655-7732
NPI assigned
Apr 21, 2022
Reactivated
Feb 27, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Gastroenterology Physician 207RG0100X 036.173749 IL Primary

Addresses

Primary practice location

530 N.E. Glen Oak Ave
Peoria, IL 61637

Mailing address

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 624-3598

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

State licenses

LicenseStateTypeSpecialty
036.173749ILMDGastroenterology Physician

NPI Registry JSON

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1154065605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-3598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 N.E. GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61637",
            "telephone_number": "309-655-6384",
            "fax_number": "309-655-7732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEKKANTI",
        "first_name": "ANKITA",
        "middle_name": "CHOWDARY",
        "name_prefix": "Miss",
        "credential": "M.B.B.S.,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-21",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "deactivation_date": "2023-01-18",
        "reactivation_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036.173749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; 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.