Kavitha Bathala, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036106265 Issued in IL

Practice address

6703 159TH St
Suite 110
Tinley Park, IL 60477-1781

Phone

(708) 444-8282

NPI assigned

Jul 25, 2006

Last updated

Dec 31, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Premise Health of Illinois Medical PC

  dba Mount Vernon Health Center Mt Vernon

  • Primary Care Clinic/Center
  • Mount Vernon, IL
  • NPI 1427366921
  Medicare reassignment NPD
• Premise Health of Illinois Medical PC

  dba MCL Health Center - Utica

  • Multi-Specialty Clinic/Center
  • Utica, IL
  • NPI 1295518868
  NPD
• Premise Health of Illinois Medical PC

  dba Premise Health Wellness Center

  • Multi-Specialty Clinic/Center
  • Northbrook, IL
  • NPI 1629716121
  NPD
• Cressa Perish MD SC

  • Family Medicine Physician
  • Flossmoor, IL
  • NPI 1467553743
  NPD (past)
• Connecticut General Life Insurance Company

  • Clinic/Center
  • Hammond, IN
  • NPI 1255757332
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356912000000",
    "number": "1861415747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1119",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604434119",
            "telephone_number": "708-747-5850",
            "fax_number": "708-747-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6703 159TH ST",
            "address_2": "SUITE 110",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771781",
            "telephone_number": "708-444-8282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BATHALA",
        "first_name": "KAVITHA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2012-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036106265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jazmin Yvonne Barragan, PT,DPT
• Sandy Barrera Ramirez
• Heather Lindsey Barrios
• Kathleen Bartgen, M.S. CCC-SLP-L
• Amanda Bartos
• Yvonne Batton, FNP-BC
• Timothy John Bauer, EMT B
• Bayberry Dental Care PC
• Alexis Becerra
• Joseph C Beck, M.D.

• Family Medicine Physician in Tinley Park, IL
• Providers in Tinley Park, 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 Dec 31, 2012; 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.

Verify at the official NPI Registry.