Individual provider Active NPI

Sivacharan Buddhavarapu, M.D.

  • Cardiovascular Disease Physician
  • Peoria, IL
National Provider Identifier
1245612092
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036.163965 Issued in IL
Practice address
112 NE Crescent Ave
Peoria, IL 61606-1901
Phone
(309) 672-4670
NPI assigned
Jun 28, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036.163965 IL Primary

Addresses

Primary practice location

112 NE Crescent Ave
Peoria, IL 61606-1901

Mailing address

112 NE Crescent Ave
Peoria, IL 61606-1901
Phone (309) 672-4670

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230629002899 IL Practitioner - Internal Medicine 4082951637 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

112 NE Crescent Ave
Peoria, IL 61606-1901
Phone (309) 672-4670

1302 N Greenwood St
Spring Valley, IL 61362-1576
Phone (779) 323-8150

1909 N Morton Ave
Morton, IL 61550-1426
Phone (309) 263-4343

2076 N Main St
Canton, IL 61520-1054
Phone (309) 674-6090

221 NE Glen Oak Ave
Peoria, IL 61636-0001

2338 W Van Winkle Way
Suite 1100
Peoria, IL 61615-7401
Phone (309) 672-4670

3591 Griffin Ave
Pekin, IL 61554-6258

5401 N Knoxville Ave
Peoria, IL 61614-5021

5409 N Knoxville Ave
Peoria, IL 61614-5069
Phone (309) 691-1000

600 S 13TH St
Pekin, IL 61554-4936

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

8914 N Knoxville Ave
Peoria, IL 61615-1410
Phone (309) 691-9110

900 Main St
Peoria, IL 61602-1060

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.163965ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Proctor Health Systems CurrentSince Aug 18, 2025 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jul 1, 2023 Accepting new patients
Proctor Health Systems CurrentSince Aug 18, 2025 Accepting new patients
Carle Health Care Incorporated Cardiovascular Disease CurrentSince Jan 1, 2026 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jul 1, 2023 Accepting new patients

Locations

1506 W Garfield Ave
Bartonville, IL 61607
Phone (309) 697-2416

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A1
Peoria, IL 61602

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

120 NE Glen Oak Ave
Peoria, IL 61603
Phone (309) 672-3158

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: sbuddhavarapu8866@prd.direct.tbh.org
  • Direct secure messaging: sbuddhavarapumd388484@carlehiedirect.net

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 and National Provider Directory roles.

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": "1435449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1245612092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 NE CRESCENT AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061901",
            "telephone_number": "309-672-4670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 NE CRESCENT AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061901",
            "telephone_number": "309-672-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUDDHAVARAPU",
        "first_name": "SIVACHARAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-28",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036.163965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.