NPIMap

Individual provider Active NPI

Deena G Raval, D.O

  • Rheumatology Physician
  • Morris, IL
National Provider Identifier
1376724773
Registry record updated May 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
036122342 Issued in IL
Practice address
1345 Edwards St
Morris, IL 60450-1691
Phone
(815) 942-9299
NPI assigned
Nov 14, 2007
Last updated
May 2, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125051090 IL
Rheumatology Physician 207RR0500X 036122342 IL Primary

Addresses

Primary practice location

1345 Edwards St
Morris, IL 60450-1691

Mailing address

201 S Wabena Ave
Suite 2B
Minooka, IL 60447-8715
Phone (815) 941-9124

Other identifiers 1

IdentifierTypeStateIssuer
036122342MedicaidIL

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
I20110926000898 IL Practitioner - Internal MedicinePractitioner - Rheumatology 1850562752 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Rheumatology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Morris HospitalGroup PAC ID 1850372459, 115 clinicians

Practice addresses (Care Compare)

1345 Edwards St
Suite 1
Morris, IL 60450-1692
Phone (815) 942-9299

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125051090ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Morris Hospital CurrentSince Feb 5, 2014 Accepting new patients
Morris Hospital CurrentSince Feb 5, 2014 Accepting new patients
Morris Hospital Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Morris Hospital Rheumatology Past Accepting new patients

Locations

580 Sycamore St
Marseilles, IL 61341
Phone (815) 795-2122

1051 W US Route 6
Ste 300
Morris, IL 60450
Phone (815) 932-7246

1345 Edwards St
Morris, IL 60450
Phone (815) 942-9299

1345 Edwards St
Ste 1
Morris, IL 60450
Phone (815) 318-5010

150 W High St
Morris, IL 60450
Phone (815) 942-2129

725 School St
Ste A
Morris, IL 60450

Interoperability endpoints

  • Direct secure messaging: deena.raval@direct-address.org

Organizations & group practices 5

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 4

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": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493683200000",
    "number": "1376724773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S WABENA AVE",
            "address_2": "SUITE 2B",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604478715",
            "telephone_number": "815-941-9124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 EDWARDS ST",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501691",
            "telephone_number": "815-942-9299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVAL",
        "first_name": "DEENA",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-14",
        "last_updated": "2017-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125051090",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "IL",
            "license": "036122342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036122342",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morris, IL

Sources for this page

Verify at the official NPI Registry.