Amando A Reniva, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036105799 Issued in IL

Practice address

6315 N Milwaukee Ave # a
Chicago, IL 60646-3760

Phone

(847) 679-1668

NPI assigned

Jul 28, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Specialty

Family Practice

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PCC Community Wellness CenterGroup PAC ID 1557270139, 91 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: amando.reniva.1@13158.direct.athenahealth.com

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.

• PCC Community Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Oak Park, IL
  • NPI 1871516799
  Medicare reassignment Care Compare group
• Emergency Medical Specialists, II, S.C.

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1689004863
  NPD (past)

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464998400000",
    "number": "1932109352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 S WASHINGTON AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684814",
            "telephone_number": "847-698-0661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6315 N MILWAUKEE AVE # A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606463760",
            "telephone_number": "847-679-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENIVA",
        "first_name": "AMANDO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2016-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036105799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID #",
            "identifier": "K01460",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1932109352",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105799",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard L Renfro, PH.D.
• Dinesh Kumar Rengarajan, M.D.
• Bryce Renicker
• Danielle A Renicker, MS, RDN, LDN, CNSC
• Irene Renieris
• Jonathan Charles Renkas, MD
• John A. Renkosik, P.A.
• Todd Christian Renn, D.C.
• Alec M Renner, DPM
• Jessica A Renner, M.A., LCPC, SOTP

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, 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 Jun 4, 2016; 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.
• 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.