Individual provider Active NPI

Dharmendra J Nimavat, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Springfield, IL
National Provider Identifier
1629052485
Registry record updated Feb 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
036-107134 Issued in IL
Practice address
415 N 9TH St
Suite 4W16
Springfield, IL 62702-5303
Phone
(217) 544-6464
Fax
(217) 757-6844
NPI assigned
Dec 5, 2005
Last updated
Feb 9, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 036-107134 IL Primary

Addresses

Primary practice location

415 N 9TH St
Suite 4W16
Springfield, IL 62702-5303

Mailing address

PO Box 19676
Springfield, IL 62794-9676
Phone (217) 544-6464

Other identifiers 1

IdentifierTypeStateIssuer
036107134MedicaidIL

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
I20050602000362 IL Practitioner - Pediatric Medicine 0143263087 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-107134ILMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siu Physicians & Surgeons, Inc CurrentSince Dec 13, 2010 Accepting new patients
St Francis Hospital of the Hospital Sisters of the Third Order of St F CurrentSince Jul 23, 2023 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Dec 13, 2010 Accepting new patients
Siu Physicians & Surgeons, Inc Past Accepting new patients

Locations

1215 Franciscan Dr
Litchfield, IL 62056
Phone (217) 324-2191

3051 Hollis Dr
Springfield, IL 62704
Phone (217) 523-5406

415 N 9th St
Springfield, IL 62702
Phone (217) 545-5117

415 N 9th St
Ste 4W16
Springfield, IL 62702
Phone (800) 331-2229

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297209600000",
    "number": "1629052485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19676",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949676",
            "telephone_number": "217-544-6464",
            "fax_number": "217-757-6844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 N 9TH ST",
            "address_2": "SUITE 4W16",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025303",
            "telephone_number": "217-544-6464",
            "fax_number": "217-757-6844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIMAVAT",
        "first_name": "DHARMENDRA",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2011-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036-107134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036107134",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.