NPIMap

Individual provider Active NPI

Hamzeh Omar Badwan I, MD

  • Family Medicine Physician
  • Watseka, IL
National Provider Identifier
1205333994
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036158327 Issued in IL
Practice address
1490 E Walnut St Ste a
Watseka, IL 60970-1833
Phone
(815) 432-7693
Fax
(815) 936-7228
NPI assigned
Apr 9, 2018
Last updated
Sep 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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
Family Medicine Physician 207Q00000X 036158327 IL Primary

Addresses

Primary practice location

1490 E Walnut St Ste a
Watseka, IL 60970-1833

Mailing address

1490 E Walnut St Ste a
Watseka, IL 60970-1833
Phone (815) 432-7693

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20211005001102 IL Practitioner - Family Practice 4385990464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

1490 E Walnut a
Watseka, IL 60970-7806
Phone (855) 432-0250

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036158327ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Sep 20, 2021 Accepting new patients
Riverside Health System CurrentSince Sep 20, 2021 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

1490 E Walnut St
Ste A
Watseka, IL 60970
Phone (815) 432-7693

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Interoperability endpoints

  • Direct secure messaging: hbadwan35775@direct.riversidehealthcare.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1523232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1205333994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 E WALNUT ST STE A",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701833",
            "telephone_number": "815-432-7693",
            "fax_number": "815-936-7228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 E WALNUT ST STE A",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701833",
            "telephone_number": "815-432-7693",
            "fax_number": "815-936-7228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADWAN",
        "first_name": "HAMZEH",
        "middle_name": "OMAR",
        "name_suffix": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-09",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036158327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watseka, IL

Sources for this page

Verify at the official NPI Registry.