NPIMap

Individual provider Active NPI

Shubhada Reddy, MD

  • Psychiatry Physician
  • Peoria, IL
National Provider Identifier
1154856607
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
T2251 Issued in TX
Practice address
221 NE Glen Oak Ave
Peoria, IL 61636
Phone
(309) 495-1640
NPI assigned
Apr 21, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 00000000000000000000 IL
Child & Adolescent Psychiatry Physician 2084P0804X T2251 TX
Psychiatry Physician 2084P0800X T2251 TX Primary

Addresses

Primary practice location

221 NE Glen Oak Ave
Peoria, IL 61636

Mailing address

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 495-1640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NY, IL3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20240205002027 TX Practitioner - Psychiatry 3577906767 Reassigns benefits to 1 organization
I20240722001704 NY Practitioner - Psychiatry 3577906767 Reassigns benefits to 1 organization
I20240731000959 IL Practitioner - Psychiatry 3577906767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCCD FL Psychiatry Services PAGroup PAC ID 4880064070, 751 clinicians

Practice addresses (Care Compare)

250 Pkwy Dr
Suite 150
Lincolnshire, IL 60069-4340
Phone (833) 351-8255

3223 S Loop
289 Suite 600
Lubbock, TX 79423-1372
Phone (833) 351-8255

Hospital & facility affiliations

  • Parkland Health & Hospital System Hospital, Dallas, TX, CCN 450015

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00000000000000000000ILMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD FL Psychiatry Services PA Psychiatry CurrentSince Mar 1, 2024 Accepting new patients
Dallas County Hospital District Current Accepting new patients
MCCD Psychiatry Services PLLC Psychiatry CurrentSince May 13, 2024 Accepting new patients

Locations

250 Parkway Dr
Ste 150
Lincolnshire, IL 60069
Phone (847) 480-1346

109 W 27th St
#55
New York, NY 10001

109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572

1800 N Britain Rd
Irving, TX 75061
Phone (214) 266-3000

3223 S Loop 289
Ste 600
Lubbock, TX 79423
Phone (405) 314-0960

1400 N Coit Rd
Ste 302
McKinney, TX 75071
Phone (214) 504-3005

Interoperability endpoints

  • Direct secure messaging: sreddy414233@direct.phhs.org

Organizations & group practices 3

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.

Hospital & facility affiliations 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1154856607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61636",
            "telephone_number": "309-495-1640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61636",
            "telephone_number": "309-495-1640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDY",
        "first_name": "SHUBHADA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-21",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "00000000000000000000",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "T2251",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "T2251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.