NPIMap

Organization Active NPI

Amar L Dave

  • Pediatrics Physician
  • Ottawa, IL
National Provider Identifier
1720523731
Registry record updated Dec 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036057338 Issued in IL
Legal business name
AMAR L DAVE
Practice address
1209 Starfire Dr
Suite 1
Ottawa, IL 61350-1614
Phone
(815) 434-2115
NPI assigned
Dec 29, 2016
Last updated
Dec 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2016

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

Authorized official

Name
Amar Lal Dave, MDNPI 1558369926
Title
MD Owner
Phone
(815) 434-2115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036057338 IL Primary

Addresses

Primary practice location

1209 Starfire Dr
Suite 1
Ottawa, IL 61350-1614

Mailing address

1209 Starfire Dr
Suite 1
Ottawa, IL 61350-1614
Phone (815) 434-2115

Other identifiers 1

IdentifierTypeStateIssuer
036057338MedicaidIL

National Provider Directory

National Provider Directory

Locations

1209 Starfire Dr
Ste 1
Ottawa, IL 61350
Phone (815) 434-2115

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482969600000",
    "number": "1720523731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 STARFIRE DR",
            "address_2": "SUITE 1",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501614",
            "telephone_number": "815-434-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 STARFIRE DR",
            "address_2": "SUITE 1",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501614",
            "telephone_number": "815-434-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAR L DAVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-29",
        "last_updated": "2016-12-29",
        "status": "A",
        "authorized_official_last_name": "DAVE",
        "authorized_official_first_name": "AMAR",
        "authorized_official_middle_name": "LAL",
        "authorized_official_title_or_position": "MD OWNER",
        "authorized_official_telephone_number": "815-434-2115",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036057338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036057338",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.