NPIMap

Individual provider Active NPI

John Davis, M.D.

  • Adolescent Medicine (Internal Medicine) Physician
  • Oak Brook, IL
National Provider Identifier
1154363372
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X
License
036109720 Issued in IL
Practice address
900 Jorie Blvd
Suite 186
Oak Brook, IL 60523-2213
Phone
(630) 954-6700
Fax
(630) 954-1555
NPI assigned
Jun 12, 2006
Last updated
Nov 16, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 01073739A IN
Adolescent Medicine (Internal Medicine) Physician 207RA0000X 036109720 IL Primary

Addresses

Primary practice location

900 Jorie Blvd
Suite 186
Oak Brook, IL 60523-2213

Mailing address

900 Jorie Blvd
Suite 186
Oak Brook, IL 60523-2213
Phone (630) 954-6700

Other identifiers 1

IdentifierTypeStateIssuer
036109720MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140416002475 IN Practitioner - HospitalistPractitioner - Internal Medicine 6608845078 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Galen Inpatient Physicians PCGroup PAC ID 3678464633, 1,045 clinicians

Practice addresses (Care Compare)

1606 N 7TH St
Vituity
Terre Haute, IN 47804-2706
Phone (812) 238-7000

901 Macarthur Blvd
Munster, IN 46321-2901
Phone (219) 836-1600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036109720ILMDAdolescent Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Galen Inpatient Physicians PC Hospitalist CurrentSince Nov 28, 2022 Accepting new patients
Galen Inpatient Physicians PC Hospitalist CurrentSince Nov 28, 2022 Accepting new patients
Galen Inpatient Physicians, PC Hospitalist Current Accepting new patients
Midwest Neoped Associates LTD PastSince Jun 28, 2009 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

901 MacArthur Blvd
Munster, IN 46321
Phone (219) 703-1443

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668556800000",
    "number": "1154363372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 JORIE BLVD",
            "address_2": "SUITE 186",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605232213",
            "telephone_number": "630-954-6700",
            "fax_number": "630-954-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 JORIE BLVD",
            "address_2": "SUITE 186",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605232213",
            "telephone_number": "630-954-6700",
            "fax_number": "630-954-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01073739A",
            "primary": false
        },
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "IL",
            "license": "036109720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036109720",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Brook, IL

Sources for this page

Verify at the official NPI Registry.