Active NPI
Augustine K Kabongo, MD
- Internal Medicine Physician
- Davenport, IA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 40864
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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, IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
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
Practice addresses (Care Compare)
1227 E Rusholme St
Mercyone Genesis
Davenport, IA 52803-2459
Phone (563) 421-1000
Hospital & facility affiliations
- Genesis Medical Center-Davenport
- Genesis HLTH System Dba Genesis MDL Ctr-Illini
- Mercyone Clinton Medical Center
- Mercyone Genesis Dewitt Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 34.85 of 100
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 40864 | IA | MD | Internal Medicine Physician |
| 036135047 | IL | MD | Internal Medicine Physician |
| 00000 | IA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complexcare Medical Group Midwest H PLLC | Internal Medicine | Current | Accepting new patients |
| Theoria Medical | Internal Medicine | Current | 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
- 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.
-
- Surgery Physician
- Davenport, IA
- NPI 1528616901
-
- General Acute Care Hospital
- Davenport, IA
- NPI 1972542264
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- De Witt, IA
- NPI 1649368523
-
- General Acute Care Hospital
- Davenport, IA
- NPI 1972542264
-
- General Acute Care Hospital
- Clinton, IA
- NPI 1427093962
-
- General Acute Care Hospital
- Silvis, IL
- NPI 1427132604
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.