Amita Ghosh, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036145083 Issued in IL

Practice address

1106 4TH Ave
Moline, IL 61265

Phone

(563) 336-3000

Fax

(563) 327-2045

NPI assigned

Jun 27, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL, IA2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aghosh635443@direct.ochin.org
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Rock Island, IL
  • NPI 1598759292
  Medicare reassignment NPD
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
  • NPI 1932193224
  Medicare reassignment NPD
• Community Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • East Moline, IL
  • NPI 1669360459
  NPD
• Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Rock Island, IL
  • NPI 1093795981
  NPD
• Community Health Care, Inc.

  • Clinical Medical Laboratory
  • Davenport, IA
  • NPI 1649461310
  NPD

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

{
    "created_epoch": "1435363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1376925289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-327-2045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 4TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "61265",
            "telephone_number": "563-336-3000",
            "fax_number": "563-327-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHOSH",
        "first_name": "AMITA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-27",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036145083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036145083",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376925289",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Genesis Health System
• Tara J Gengler, APN
• Genventures, Inc.
• Genventures, Inc.
• Maged Ghoprial, M.D
• Gi Pathology LLC
• Andrew Gibson, DPT
• Dana Gibson, ARNP
• Lindsey Rae Gidel, OTD, OTR/L
• Shannon Rose Gier, LMFT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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.