Gregg E Davis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-058885 Issued in IL

Practice address

204 Park Ave E
Princeton, IL 61356-2114

Phone

(815) 879-3212

Fax

(815) 879-8602

NPI assigned

Jun 9, 2006

Last updated

Feb 18, 2015By 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 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

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.

• Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Aurora, IL
  • NPI 1932375169
  Medicare reassignment NPD
• Gregg E Davis MD LTD

  • Primary Care Clinic/Center
  • Princeton, IL
  • NPI 1447481908
  Authorized official Same address or phone
• Community Health Partnership of Illinois

  dba Princeville Medical Center

  • Federally Qualified Health Center (FQHC)
  • Princeville, IL
  • NPI 1336767540
  NPD
• Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Rantoul, IL
  • NPI 1942619606
  NPD
• Julia Rackley Perry Memorial Hospital

  dba Perry Home Care

  • Home Health Agency
  • Princeton, IL
  • NPI 1932191806
  NPD (past)
• Mullin Memorial Health Services LLC

  dba Mullin Memorial Rural Health Clinic

  • Rural Health Clinic/Center
  • Manlius, IL
  • NPI 1902977424
  NPD (past)
• Mullin Memorial Rural Health Services, LLC

  dba Mullin Memorial Rural Health Clinic

  • Family Nurse Practitioner
  • Manlius, IL
  • NPI 1851346316
  NPD (past)
• Princeton Emergency Services, LLC

  • Nurse Practitioner
  • Princeton, IL
  • NPI 1134187875

  Emergency Medicine

  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424217600000",
    "number": "1306887674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 PARK AVE E",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613562114",
            "telephone_number": "815-879-3212",
            "fax_number": "815-879-8602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 PARK AVE E",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613562114",
            "telephone_number": "815-879-3212",
            "fax_number": "815-879-8602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GREGG",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2015-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "36058885",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-058885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Jo Derubeis, APRN
• Geetha Dodda, MD
• Donald R Marion OD

• Family Medicine Physician in Princeton, IL
• Providers in Princeton, 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 Feb 18, 2015; 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.