NPIMap

Organization Active NPI

Innovative Physician Services LLC

  • Physical Medicine & Rehabilitation Physician
  • Springfield, MA
National Provider Identifier
1922096049
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
INNOVATIVE PHYSICIAN SERVICES LLC
Practice address
490 Page Boulevard
Springfield, MA 01104
Phone
(413) 349-5063
Fax
(413) 363-2857
NPI assigned
Oct 12, 2005
Last updated
Aug 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Authorized official

Name
Dr. Adnan M Dahdul, M.D.NPI 1104802362
Title
Owner/Ceo/Officer
Phone
(413) 301-6019

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 8

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

490 Page Boulevard
Springfield, MA 01104

Mailing address

95 Frank B Murray St
Springfield, MA 01103-1106
Phone (413) 301-6019

Other practice location 1

512 W Cherry St Ste C
Kissimmee, FL 34741-4114
Phone (321) 400-5013

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040427000199 MA Part B Supplier - Clinic/Group Practice 1456348127 Receives reassigned benefits from 30 practitioners
Practice locations: Dorchester, MA; Worcester, MA; Springfield, MA; Holyoke, MA; East Longmeadow, MA; Chicopee, MA; Chelsea, MA
O20221206001271 FL Part B Supplier - Clinic/Group Practice 1456348127 Receives reassigned benefits from 4 practitioners
Practice locations: Kissimmee, FL; Naples, FL

National Provider Directory

National Provider Directory

Locations

8803 Vistana Centre Dr
Orlando, FL 32821
Phone (413) 301-6019

67 Hunt St
Agawam, MA 01001
Phone (413) 318-4776

2001 Washington St
Braintree, MA 02184
Phone (781) 848-2600

84 Main St
Chicopee, MA 01020
Phone (413) 331-5660

779 Dudley St
Dorchester, MA 02125
Phone (413) 301-6019

171 Pine St
Holyoke, MA 01040
Phone (413) 437-7488

217 High St
Holyoke, MA 01040
Phone (413) 301-6019

69 Jackson St
Holyoke, MA 01040
Phone (413) 455-3625

1200 Converse St
Ste L3
Longmeadow, MA 01106
Phone (413) 567-4200

490 Page Blvd
Springfield, MA 01104
Phone (413) 349-5033

819 Worcester St
Ste 1
Springfield, MA 01151
Phone (337) 408-0805

933 E Columbus Ave
Springfield, MA 01105
Phone (413) 301-6019

753 Union St
#B
West Springfield, MA 01089
Phone (413) 209-9739

20 E Worcester St
Worcester, MA 01604
Phone (508) 363-6030

554 Main St
Worcester, MA 01608
Phone (413) 301-6019

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754438400000",
    "number": "1922096049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 FRANK B MURRAY ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011031106",
            "telephone_number": "413-301-6019",
            "fax_number": "413-363-2857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 PAGE BOULEVARD",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "01104",
            "telephone_number": "413-349-5063",
            "fax_number": "413-363-2857"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "512 W Cherry St Ste C",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347414114",
            "country_code": "US",
            "telephone_number": "321-400-5013",
            "fax_number": "413-363-9123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INNOVATIVE PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A",
        "authorized_official_last_name": "DAHDUL",
        "authorized_official_first_name": "ADNAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/CEO/OFFICER",
        "authorized_official_telephone_number": "413-301-6019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.