Amirreza Fallahi, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036166275 Issued in IL

Practice address

400 S Kennedy Dr Ste 300
Bradley, IL 60915-2682

Phone

(815) 937-1237

Fax

(815) 933-0662

NPI assigned

Mar 24, 2020

Last updated

Jul 16, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Riverside Health System

  • General Practice Physician
  • Kankakee, IL
  • NPI 1417061193
  Medicare reassignment NPD
• Riverside Health System

  dba Psychiatric Associates

  • Psychiatry Physician
  • Kankakee, IL
  • NPI 1336354430
  NPD

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1235766916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S KENNEDY DR STE 300",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609152682",
            "telephone_number": "815-937-1237",
            "fax_number": "815-933-0662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S KENNEDY DR STE 300",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609152682",
            "telephone_number": "815-937-1237",
            "fax_number": "815-933-0662"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 N Wall St",
            "address_purpose": "LOCATION",
            "city": "Kankakee",
            "state": "IL",
            "postal_code": "609012991",
            "country_code": "US",
            "telephone_number": "815-937-1237",
            "fax_number": "815-933-0662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FALLAHI",
        "first_name": "AMIRREZA",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036166275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Koren Dinello, NP-C
• Dr.Joseph Mayotte D.C P.C
• Shannon Ducat
• Paula Renee Dykstra, LCSW
• Kaase Gayl El-Talabani
• Parmis Fatih, MD
• Kristin L Fields, PA-C
• Katherine Jane Ford, LCPC
• Mary Ann Salera Garcia, PT
• Rosaura Garcia, FNP-BC

• Psychiatry Physician in Bradley, IL
• Providers in Bradley, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.