Alyve Medical PLLC Family Medical Clinic

Primary specialty

Obesity Medicine (Internal Medicine) PhysicianTaxonomy code 207RB0002X

Legal business name

ALYVE MEDICAL PLLC FAMILY MEDICAL CLINIC

Practice address

1480 N Green Mount Rd Ste 200
O Fallon, IL 62269-3466

Phone

(618) 622-3450

Fax

(618) 622-3468

NPI assigned

Dec 20, 2021

Last updated

Jan 6, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amardeep Shrestha, MDNPI 1730490525

Title

Manager

Phone

(217) 801-8156

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amardeep Shrestha, M.D.

  • Internal Medicine Physician
  • O'Fallon, IL
  • NPI 1730490525
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1295495208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "783 ALLENBROOK AVE",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697455",
            "telephone_number": "217-801-8156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 N GREEN MOUNT RD STE 200",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693466",
            "telephone_number": "618-622-3450",
            "fax_number": "618-622-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALYVE MEDICAL PLLC FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-20",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "SHRESTHA",
        "authorized_official_first_name": "AMARDEEP",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-801-8156",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obesity Medicine (Internal Medicine) Physician in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• Obesity Medicine (Internal Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.