NPIMap

Individual provider Active NPI

Ahmed A. Radwan, M.D.

  • Sports Medicine (Family Medicine) Physician
  • O'Fallon, IL
National Provider Identifier
1376575126
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
036114529 Issued in IL
Practice address
670 Pierce Blvd
O Fallon, IL 62269-2579
Phone
(618) 206-2070
Fax
(618) 206-2071
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 036114529 IL Primary

Addresses

Primary practice location

670 Pierce Blvd
O Fallon, IL 62269-2579

Mailing address

1512 N Green Mount Rd
Suite 200
O Fallon, IL 62269-1953
Phone (618) 624-1860

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aradwan31912@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061201000037 IL Practitioner - Family Practice 0547268476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Medical Group IncGroup PAC ID 5092857821, 212 clinicians

Practice addresses (Care Compare)

1512 N Green Mount Rd
Suite 108
Ofallon, IL 62269-1953
Phone (618) 624-5510

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036114529ILMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
HSHS Medical Group Inc CurrentSince Jul 1, 2010 Accepting new patients
HSHS Medical Group Inc CurrentSince Jul 1, 2010 Accepting new patients
HSHS Medical Group Inc Past Accepting new patients

Locations

211 S 3rd St
Belleville, IL 62220
Phone (618) 234-2700

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

1512 N Green Mount Rd
Ste 200
O Fallon, IL 62269
Phone (618) 624-1860

670 Pierce Blvd
O Fallon, IL 62269
Phone (618) 206-2070

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

1512 N Green Mount Rd
Ste 108
O Fallon, IL 62269
Phone (618) 624-5510

3051 Hollis Dr
Springfield, IL 62704
Phone (217) 523-5406

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1376575126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 N GREEN MOUNT RD",
            "address_2": "SUITE 200",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691953",
            "telephone_number": "618-624-1860",
            "fax_number": "618-624-1863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 PIERCE BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692579",
            "telephone_number": "618-206-2070",
            "fax_number": "618-206-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADWAN",
        "first_name": "AHMED",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IL",
            "license": "036114529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aradwan31912@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "670 Pierce Blvd",
            "city": "O Fallon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622692579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

Verify at the official NPI Registry.