Individual provider Active NPI

Subramanyam Chittivelu, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Peoria, IL
National Provider Identifier
1932195880
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
036105660 Issued in IL
Practice address
1001 Main St
Suite 200
Peoria, IL 61606-1907
Phone
(309) 672-5682
Fax
(309) 672-3147
NPI assigned
Sep 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 036105660 IL
Sleep Medicine (Internal Medicine) Physician 207RS0012X 036105660 IL
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 036105660 IL Primary

Addresses

Primary practice location

1001 Main St
Suite 200
Peoria, IL 61606-1907

Mailing address

1001 Main St
Suite 200
Peoria, IL 61606-1907
Phone (309) 672-5682

Other identifiers 2

IdentifierTypeStateIssuer
IL2690008OtherMEDICARE PTAN
036105660MedicaidIL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100129000479 IL Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 6709846884 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

1001 Main St
Suite 200
Peoria, IL 61606-2035
Phone (309) 672-5682

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
33117TXMDDentist
036105660ILMDSleep Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients

Locations

1505 Eastland Dr
Ste 1100
Bloomington, IL 61701
Phone (309) 663-2100

801 Fox Run
Heyworth, IL 61745
Phone (309) 473-2069

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1001 Main St
Ste 200
Peoria, IL 61606
Phone (309) 308-2010

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

Organizations & group practices 2

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1932195880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST",
            "address_2": "SUITE 200",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061907",
            "telephone_number": "309-672-5682",
            "fax_number": "309-672-3147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST",
            "address_2": "SUITE 200",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061907",
            "telephone_number": "309-672-5682",
            "fax_number": "309-672-3147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHITTIVELU",
        "first_name": "SUBRAMANYAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036105660",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "IL",
            "license": "036105660",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IL",
            "license": "036105660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IL2690008",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105660",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.