Risha Raven Fennell, MD

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

036100518 Issued in IL

Practice address

2501 Chatham Rd Ste 4713
Springfield, IL 62704-4188

Phone

(779) 429-2227

NPI assigned

Mar 8, 2006

Last updated

Jun 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Risha O'Connor Raven Former name

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

Specialty

Addiction MedicineAlso: Family Practice

Education

Northwestern University Feinberg Medical School, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Improvement CenterGroup PAC ID 4385625342, shared by 3 NPIs, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: risha.fennellmd.p31@direct.fhn-fqhc.nextgenshare.com

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.

• Dr Dean Ornish Lifestyle Medicine PC

  • Cardiac Rehabilitation Clinic/Center
  • Sausalito, CA
  • NPI 1508571639
  NPD
• Community Health Improvement Center

  dba Crossing Healthcare

  • Federally Qualified Health Center (FQHC)
  • Decatur, IL
  • NPI 1194794917
  NPD (past)
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• KSB Medical Group, Inc.

  • Family Medicine Physician
  • Dixon, IL
  • NPI 1073592119
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Decatur Memorial Hospital

  • General Acute Care Hospital
  • Decatur, IL
  • NPI 1548357973
  Care Compare affiliation

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1487622379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 BEECH ST",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617611803",
            "telephone_number": "779-429-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 CHATHAM RD STE 4713",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627044188",
            "telephone_number": "779-429-2227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1096 1350th St",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "IL",
            "postal_code": "626565094",
            "country_code": "US",
            "telephone_number": "217-735-5581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENNELL",
        "first_name": "RISHA",
        "middle_name": "RAVEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036100518",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "IL",
            "license": "036100518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036100518",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RISHA",
            "last_name": "RAVEN",
            "middle_name": "O'CONNOR",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kara Michelle Fellers, APRN
• Olivia Nicole Felts
• Emily Ann Fendrich, PA-C
• Kelly Feng, MD
• Kelly Marie Fening, DO
• Tiffany Fenner
• Nicholas M. Fenwick, APRN
• Kristen L Ferguson, M.D.
• Rebecca L. Ferguson, C.F.N.P.
• Tiffany Ferguson, FNP-BC

• Addiction Medicine (Family Medicine) Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Addiction Medicine (Family Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.

Verify at the official NPI Registry.