Individual provider Active NPI

Ruby Raju, DO

  • Pediatrics Physician
  • Springfield, IL
National Provider Identifier
1417570490
Registry record updated May 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
125076600 Issued in IL
Practice address
400 N 9TH St # 4a
Springfield, IL 62702-5310
Phone
(217) 545-8000
NPI assigned
May 25, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 125076600 IL Primary

Addresses

Primary practice location

400 N 9TH St # 4a
Springfield, IL 62702-5310

Mailing address

PO Box 19658
Springfield, IL 62794-9658

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250801001183 IL Practitioner - Pediatric Medicine 7416372248 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125076600ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of the University of Illinois Pediatrics CurrentSince Jul 15, 2025 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jul 15, 2025 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1590364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590364800000",
    "number": "1417570490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19658",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N 9TH ST # 4A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025310",
            "telephone_number": "217-545-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJU",
        "first_name": "RUBY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-25",
        "last_updated": "2020-05-25",
        "certification_date": "2020-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125076600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.