NPIMap

Individual provider Active NPI

Prashanth Ravikiran Tamragouri, M.D.

  • Psychiatry Physician
  • Downers Grove, IL
National Provider Identifier
1720344526
Registry record updated Dec 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036138017 Issued in IL
Practice address
1909 Ogden Ave Ste a
Downers Grove, IL 60515-2602
Phone
(630) 750-7920
NPI assigned
Apr 5, 2012
Last updated
Dec 29, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036138017 IL Primary
Geriatric Psychiatry Physician 2084P0805X 036138017 IL

Addresses

Primary practice location

1909 Ogden Ave Ste a
Downers Grove, IL 60515-2602

Mailing address

1909 Ogden Ave Ste a
Downers Grove, IL 60515-2602
Phone (630) 750-7920

Other practice location 1

2160 S 1st Ave
Psychiatry and Behavioral Neurosciences Fahey Room 222
Maywood, IL 60153-3328
Phone (708) 216-3750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170309000647 IL Practitioner - Psychiatry 2668772245 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Toledo Medical College, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Health Hub LLCGroup PAC ID 3274817481, 16 clinicians

Practice addresses (Care Compare)

1909 Ogden Ave
Suite a
Downers Grove, IL 60515-2602
Phone (630) 750-7920

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
19.36 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
64.52

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036138017ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center Current Accepting new patients
Health Hub, LLC Geriatric Psychiatry CurrentSince Feb 1, 2017 Accepting new patients

Locations

1909 Ogden Ave
Ste A
Downers Grove, IL 60515
Phone (630) 750-7920

2160 S 1st Ave
Rm 222
Maywood, IL 60153
Phone (708) 216-3750

Interoperability endpoints

  • Direct secure messaging: ptamragouri47551@direct.luhs.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wheaton Village Nursing and Rehabilitation CenterWheaton, IL, CCN 145715 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 1, 2018
Dec 1, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 7

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": "1333584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514505600000",
    "number": "1720344526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 OGDEN AVE STE A",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605152602",
            "telephone_number": "630-750-7920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 OGDEN AVE STE A",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605152602",
            "telephone_number": "630-750-7920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2160 S 1st Ave",
            "address_2": "Psychiatry and Behavioral Neurosciences Fahey Room 222",
            "address_purpose": "LOCATION",
            "city": "Maywood",
            "state": "IL",
            "postal_code": "601533328",
            "country_code": "US",
            "telephone_number": "708-216-3750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAMRAGOURI",
        "first_name": "PRASHANTH",
        "middle_name": "RAVIKIRAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-05",
        "last_updated": "2017-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036138017",
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "IL",
            "license": "036138017",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downers Grove, IL

Sources for this page

Verify at the official NPI Registry.