NPIMap

Individual provider Active NPI

Karla Rae Ambroz, MD

  • Family Medicine Physician
  • Urbana, IL
National Provider Identifier
1750336103
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036103211 Issued in IL
Practice address
1109 S Lincoln Ave
Urbana, IL 61801-4703
Phone
(217) 333-2711
Fax
(217) 244-1758
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 6650A WY
Family Medicine Physician 207Q00000X 9801139 NC
Family Medicine Physician 207Q00000X 036103211 IL Primary

Addresses

Primary practice location

1109 S Lincoln Ave
Urbana, IL 61801-4703

Mailing address

PO Box 13044
Jackson, WY 83002-3044
Phone (307) 739-1099

Other names 1

  • K. Rae Ambroz Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036103211ILMDFamily Medicine Physician
9801139NCMDFamily Medicine Physician
6650AWYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Four Peaks Clinic Urgent Care, Inc Family Medicine Past Accepting new patients
West Suburban Medical Center Family Medicine Past Accepting new patients
Womens Health & Family Care, LLC Family Medicine Past Accepting new patients
Womens Health Center Family Medicine Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1750336103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13044",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830023044",
            "telephone_number": "307-739-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 S LINCOLN AVE",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618014703",
            "telephone_number": "217-333-2711",
            "fax_number": "217-244-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBROZ",
        "first_name": "KARLA",
        "middle_name": "RAE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "6650A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9801139",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036103211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "K.",
            "last_name": "AMBROZ",
            "middle_name": "RAE",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Urbana, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; 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.