Individual provider Active NPI

Arvind Reddy Devanabanda

  • Cardiovascular Disease Physician
  • Peoria, IL
National Provider Identifier
1578974069
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036158345 Issued in IL
Practice address
900 Main St Ste 660
Peoria, IL 61602-1060
Phone
(309) 672-4760
NPI assigned
May 19, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X A171266 CA
Student in an Organized Health Care Education/Training Program 390200000X
Cardiovascular Disease Physician 207RC0000X 036158345 IL Primary

Addresses

Primary practice location

900 Main St Ste 660
Peoria, IL 61602-1060

Mailing address

611 W Park St
Fapc
Urbana, IL 61801-2500

Other practice location 1

550 First Avenue
New York, NY 10016-9998
Phone (212) 263-6397

Other practice location 2

127 S San Vicente Blvd Ste A3600
Los Angeles, CA 90048-3311
Phone (310) 423-3977

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
I20220513000075 IL Practitioner - Internal MedicinePractitioner - Interventional Cardiology 9830449529 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Interventional Cardiology
Education
Boston University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

112 NE Crescent Ave
Peoria, IL 61606-1901
Phone (309) 672-4670

1909 N Morton Ave
Morton, IL 61550-1426
Phone (309) 263-4343

201 N Cummings LN
Washington, IL 61571-2181
Phone (309) 444-3627

205 N Cummings LN
Suite B
Washington, IL 61571-2181
Phone (309) 691-6610

209 N Cummings LN
Washington, IL 61571-2181
Phone (309) 643-6185

221 NE Glen Oak Ave
Peoria, IL 61636-0001

5409 N Knoxville Ave
Peoria, IL 61614-5069
Phone (309) 691-1000

600 S 13TH St
Pekin, IL 61554-4936

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

900 Main St
Peoria, IL 61602-1060

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting94
Pacemaker insertion or repair1-10
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
281131NYMDCommunity Health Worker
036158345ILMDCardiovascular Disease Physician
A171266CAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Proctor Health Systems CurrentSince Jul 1, 2022 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jul 1, 2022 Accepting new patients
Methodist Medical Center of Illinois Interventional Cardiology CurrentSince Jul 1, 2022 Accepting new patients
Proctor Health Systems CurrentSince Jul 1, 2022 Accepting new patients
Carle Health Care Incorporated Cardiovascular Disease CurrentSince Nov 25, 2024 Accepting new patients
Carle Health Care Incorporated Past Accepting new patients

Locations

1506 W Garfield Ave
Bartonville, IL 61607
Phone (309) 697-2416

600 S 13th St
Ste D
Pekin, IL 61554
Phone (309) 347-2700

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 671-3000

2338 W Van Winkle Way
Ste 1100
Peoria, IL 61615

815 Main St
Ste A1
Peoria, IL 61602

5401 N Knoxville Ave
Ste 217
Peoria, IL 61614
Phone (309) 282-1864

900 Main St
Ste 660
Peoria, IL 61602
Phone (309) 272-7724

5401 N Knoxville Ave
Ste 207
Peoria, IL 61614
Phone (309) 672-4640

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

530 Park Ave E
Ste 409
Princeton, IL 61356

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: adevanabandamd388527@carlehiedirect.net

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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": "1400457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1578974069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MAIN ST STE 660",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021060",
            "telephone_number": "309-672-4760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 First Avenue",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100169998",
            "country_code": "US",
            "telephone_number": "212-263-6397",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "127 S San Vicente Blvd Ste A3600",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900483311",
            "country_code": "US",
            "telephone_number": "310-423-3977",
            "fax_number": "310-423-6795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEVANABANDA",
        "first_name": "ARVIND REDDY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-19",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "A171266",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036158345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.