Avinash Mantha, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036147326 Issued in IL

Practice address

3046 127TH St
Blue Island, IL 60406-1827

Phone

(708) 377-7920

Fax

(708) 930-0414

NPI assigned

Apr 14, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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 Medicine

State licenses

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1275952731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3046 127TH ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061827",
            "telephone_number": "708-377-7920",
            "fax_number": "708-930-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3046 127TH ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061827",
            "telephone_number": "708-377-7920",
            "fax_number": "708-930-0414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 Arch St",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "NY",
            "postal_code": "137902102",
            "country_code": "US",
            "telephone_number": "607-763-6075",
            "fax_number": "607-763-5234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANTHA",
        "first_name": "AVINASH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-14",
        "last_updated": "2018-10-30",
        "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": "036147326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine Lynch, LCSW
• Hoda Mahmoud, DMD
• Malinda Mommy'S Helper LLC
• Kevin Paul Malone, D.P.M.
• Ramon Manglano, MD
• Angela Merari Martinez
• Barbara Jean Massette, LCPC
• John Thomas Matera, MD
• Lynjunita Loeese Matsey, LSW
• Toby Maxwell

• Family Medicine Physician in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; 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.