Pushpa K Mamtani, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

36 064091 Issued in IL

Practice address

5666 E State St
Rockford, IL 61108-2425

Phone

(815) 226-2000

NPI assigned

Dec 5, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Pushpa Balasubramanian Former name

Medicare fee-for-service enrollment

Enrolled in IL, WI2 enrollments

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 2

Specialty

Pediatric Medicine

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pushpa.mamtani@direct.forthc.com

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.

• Divine Savior Healthcare, Inc.

  dba Aspirus Divine Savior Hospital

  • General Acute Care Hospital
  • Portage, WI
  • NPI 1124083894
  Medicare reassignment NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Divine Savior Healthcare, Inc.

  dba Aspirus Portage Clinic

  • Rural Health Clinic/Center
  • Portage, WI
  • NPI 1386154417
  NPD
• Freeport Memorial Hospital

  • Health Educator
  • Freeport, IL
  • NPI 1326880386
  NPD (past)
• Health Progress, Inc.

  dba dba Kish Health Family Care

  • Family Medicine Physician
  • Shabbona, IL
  • NPI 1093898801
  NPD (past)

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1376527168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5666 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082425",
            "telephone_number": "815-226-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5666 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082425",
            "telephone_number": "815-226-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1614 E Norris Dr",
            "address_purpose": "LOCATION",
            "city": "Ottawa",
            "state": "IL",
            "postal_code": "613503681",
            "country_code": "US",
            "telephone_number": "815-433-1010",
            "fax_number": "815-433-0067",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAMTANI",
        "first_name": "PUSHPA",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-05",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301503653",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "36 064091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01932040",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036064091",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PUSHPA",
            "last_name": "BALASUBRAMANIAN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laurel Kristine Malloy
• Latoya Renee Malone, LCSW
• Madeline Malone, PT, DPT
• Genevieve Maltby, LCSW
• Courtnea D Malugen, N.P.
• Joel M. Manaligod, M.D.
• Arturo Santiago Manas, M.D.
• Dhivyalakshmi Manavazhagan, DDS
• Krishna K R Manda, MD
• Kris James Manders

• Pediatrics Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.
• 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.