NPIMap

Individual provider Active NPI

Ebrahim Amani, M.D.

  • Family Medicine Physician
  • Batavia, IL
National Provider Identifier
1386615904
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3695344 Issued in IL
Practice address
1049 E Wilson St
Suite 160B
Batavia, IL 60510-2474
Phone
(630) 232-2776
NPI assigned
Jan 31, 2006
Last updated
Dec 13, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 3695344 IL Primary
General Practice Physician 208D00000X 36-95344 IL

Addresses

Primary practice location

1049 E Wilson St
Suite 160B
Batavia, IL 60510-2474

Mailing address

1049 E Wilson St
Suite 160B
Batavia, IL 60510-2474
Phone (630) 232-2776

Other identifiers 5

IdentifierTypeStateIssuer
920540035OtherILMEDICARE PTAN (INDIVIDUAL)
CA4748OtherILMEDICARE RAIL ROAD PTAN (GROUP)
036095344MedicaidIL
920540OtherILMEDICARE PTAN (GROUP)
P01160490OtherILMEDICARE RAIL ROAD PTAN (INDIVIDUAL)

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
I20061218000172 IL Practitioner - Family Practice 5496754699 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

1049 E Wilson St
160B
Batavia, IL 60510-3174
Phone (630) 232-2776

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3695344ILMDFamily Medicine Physician
36-95344ILMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group Family Medicine CurrentSince Jan 28, 2013 Accepting new patients
Central Dupage Physician Group CurrentSince Jan 28, 2013 Accepting new patients
Well Spring Family Physicians, LLC Family Medicine PastSince Jan 2, 2007 Accepting new patients

Locations

1049 E Wilson St
Ste 160B
Batavia, IL 60510
Phone (630) 232-2776

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

2570 Foxfield Rd
Ste 100
St Charles, IL 60174
Phone (630) 584-1950

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

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": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386892800000",
    "number": "1386615904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 E WILSON ST",
            "address_2": "SUITE 160B",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605102474",
            "telephone_number": "630-232-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 E WILSON ST",
            "address_2": "SUITE 160B",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605102474",
            "telephone_number": "630-232-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMANI",
        "first_name": "EBRAHIM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2013-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "3695344",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "36-95344",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (INDIVIDUAL)",
            "identifier": "920540035",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD PTAN (GROUP)",
            "identifier": "CA4748",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095344",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (GROUP)",
            "identifier": "920540",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD PTAN (INDIVIDUAL)",
            "identifier": "P01160490",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Batavia, IL

Sources for this page

Verify at the official NPI Registry.