Individual provider Active NPI

Augustine K Kabongo, MD

  • Internal Medicine Physician
  • Davenport, IA
National Provider Identifier
1467795930
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
40864 Issued in IA
Practice address
1227 E Rusholme St
Davenport, IA 52803-2459
Phone
(563) 421-7882
NPI assigned
Apr 2, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 00000 IA
Internal Medicine Physician 207R00000X 036135047 IL
Internal Medicine Physician 207R00000X 40864 IA Primary

Addresses

Primary practice location

1227 E Rusholme St
Davenport, IA 52803-2459

Mailing address

1227 E Rusholme St
Davenport, IA 52803-2459
Phone (563) 421-7882

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, IL2 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

Enrollment IDStateProvider typePAC IDDetails
I20130827000292 IA Practitioner - Internal Medicine 6709029515 Reassigns benefits to 2 organizations
I20140926002257 IL Practitioner - Internal Medicine 6709029515 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Health SystemGroup PAC ID 6103829338, 262 clinicians

Practice addresses (Care Compare)

1227 E Rusholme St
Mercyone Genesis
Davenport, IA 52803-2459
Phone (563) 421-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
34.85 of 100Reported as group
Quality
21.4
Improvement activities
0
Cost
76.92

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40864IAMDInternal Medicine Physician
036135047ILMDInternal Medicine Physician
00000IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Complexcare Medical Group Midwest H PLLC Internal Medicine CurrentSince Jul 14, 2025 Accepting new patients
Theoria Medical Internal Medicine CurrentSince Jul 15, 2024 Accepting new patients
Genesis Health System Past Accepting new patients

Locations

2001 1st Ave N
Estherville, IA 51334
Phone (712) 362-3594

471 W Terra Cotta Ave
Crystal Lake, IL 60014
Phone (815) 455-0550

525 S Macon St
Moweaqua, IL 62550
Phone (217) 433-2020

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

Interoperability endpoints

  • Direct secure messaging: augustine.kabongo@direct.genesishealth.com

Organizations & group practices 4

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": "1364860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1467795930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 E RUSHOLME ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032459",
            "telephone_number": "563-421-7882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 E RUSHOLME ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032459",
            "telephone_number": "563-421-7882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KABONGO",
        "first_name": "AUGUSTINE",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-02",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "00000",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036135047",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "40864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.