Active NPI
Kavya Shivaram, MD
- Dermatology Physician
- Springfield, IL
National Provider Identifier
1689569105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 125086214
- Practice address
- 751 N Rutledge St Ste 2300
Springfield, IL 62702-4968 - Phone
- (217) 545-8000
- NPI assigned
- Jun 12, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 125086214 | IL | Primary |
Addresses
Primary practice location
751 N Rutledge St Ste 2300
Springfield, IL 62702-4968
Mailing address
PO Box 19644
Springfield, IL 62794-9644
Phone (217) 545-8000
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250704000359 | IL | Order and Referring Only - Dermatology | 7719491570 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125086214 | IL | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749686400000",
"number": "1689569105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19644",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627949644",
"telephone_number": "217-545-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 N RUTLEDGE ST STE 2300",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627024968",
"telephone_number": "217-545-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIVARAM",
"first_name": "KAVYA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-12",
"last_updated": "2025-06-12",
"certification_date": "2025-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "IL",
"license": "125086214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.