Ninva Medical Group LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NINVA MEDICAL GROUP LLC

Practice address

8780 W Golf Rd Ste 303
Niles, IL 60714-5611

Phone

(847) 813-6579

NPI assigned

Jul 27, 2021

Last updated

Jul 27, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dany Mamou, MDNPI 1679704100

Title

Owner

Phone

(773) 412-1234

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25060/brand/1/csg/1/fhir/r4

Practitioners 1

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.

• Dany Mamou, M.D.

  • Family Medicine Physician
  • Sturgis, MI
  • NPI 1679704100

  IL

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627344000000",
    "number": "1841963881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8780 W GOLF RD STE 303",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607145611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8780 W GOLF RD STE 303",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607145611",
            "telephone_number": "847-813-6579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NINVA MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "MAMOU",
        "authorized_official_first_name": "DANY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-412-1234",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Niles Elementary Dist 71
• Niles Medical S.C.
• Niles Nursing & Rehabilitation Center, LLC
• Niles Open MRI Inc
• Niles Surgery Center LLC
• Meer Nisengolts, M.D.
• Rachel Nitzarim, PH.D
• Nessa Nkemnji, M.S.
• Rina K Norris, PSY.D.
• North Branch Dermatology LLC

• Family Medicine Physician in Niles, IL
• Providers in Niles, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.