Active NPI
Michael P Bova, M.D.
- Internal Medicine Physician
- Springfield, IL
National Provider Identifier
1861489510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Practice address
- 2524 Farragut Dr
Suite C
Springfield, IL 62704-8400 - Phone
- (217) 726-9346
- NPI assigned
- Sep 27, 2005
- Last updated
- Nov 6, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | IL | Primary |
Addresses
Primary practice location
2524 Farragut Dr
Suite C
Springfield, IL 62704-8400
Mailing address
2524 Farragut Dr
Suite C
Springfield, IL 62704-8400
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00063271 | Other | IL | RAILROAD MEDICARE |
| 088405 | Other | IL | HEALTH ALLIANCE |
| 166621 | Other | IL | HEALTHLINK NETWORK ID |
| 3003 | Other | IL | NEIC SITE ID,NSF BAO-7 |
| 08432082 | Other | IL | BLUE CROSS BLUE SHIELD |
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)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-075342 | IL | MD | Internal Medicine Physician |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Springfield, IL
- NPI 1063538809
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194307200000",
"number": "1861489510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2524 FARRAGUT DR",
"address_2": "SUITE C",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627048400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2524 FARRAGUT DR",
"address_2": "SUITE C",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627048400",
"telephone_number": "217-726-9346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOVA",
"first_name": "MICHAEL",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-27",
"last_updated": "2007-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00063271",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "088405",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK NETWORK ID",
"identifier": "166621",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIC SITE ID,NSF BAO-7",
"identifier": "3003",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "08432082",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.