Individual provider Active NPI

Harshavardhan Reddy Ghadiam, M.D

  • Cardiovascular Disease Physician
  • Peoria, IL
National Provider Identifier
1437583077
Registry record updated Jun 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036139804 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 624-9351
NPI assigned
Aug 31, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2023

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 125063220 IL
Cardiovascular Disease Physician 207RC0000X 036139804 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

530 NE Glen Oak Ave
Peoria, IL 61637-3140
Phone (309) 655-7257

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
I20160602000709 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0446571343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

530 Neglen Oak Ave
Suite 1200
Peoria, IL 61637-0001
Phone (309) 624-7811

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125063220ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

1051 W South St
Kewanee, IL 61443
Phone (309) 734-3141

530neglen Oak Ave 1200
Peoria, IL 61637
Phone (309) 624-7811

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

5405 N Knoxville Ave
Peoria, IL 61614
Phone (309) 691-4410

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

530 Park Ave E
Ste 303A
Princeton, IL 61356
Phone (815) 876-3179

Organizations & group practices 2

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.

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": "1377907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687564800000",
    "number": "1437583077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616373140",
            "telephone_number": "309-655-7257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-9351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHADIAM",
        "first_name": "HARSHAVARDHAN",
        "middle_name": "REDDY",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-31",
        "last_updated": "2023-06-24",
        "certification_date": "2023-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125063220",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036139804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.