Sabeeha Haque Ali MD LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

036109029 Issued in IL

Legal business name

SABEEHA HAQUE ALI MD LLC

Doing business as

Riverview Pediatrics

Practice address

102 N Logan Ave
Danville, IL 61832-8513

Phone

(217) 442-5863

Fax

(217) 442-5040

NPI assigned

Sep 3, 2013

Last updated

Nov 12, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sabeeha Haque, M.D.

Title

Owner/Manager

Phone

(312) 545-9727

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Riverview Pediatrics Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972937480. Details of each certification follow.

• CCN 148931 Rural health clinic · Active · Details

Rural health clinic certification: CCN 148931

Legal name

SABEEHA HAQUE ALI MD LLC

Doing business as

RIVERVIEW PEDIATRICS

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 1, 2001

Last certification

Aug 28, 2020

Ownership / control type

1B

Most recent change of ownership

Nov 1, 2013 (2 total)

Organization structure

LLCProprietary

Incorporated

in IL

Enrollment address

102 N Logan Ave
Danville, IL 61832-8513

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Sabeeha Haque Ali, MD

  • Pediatrics Physician
  • Danville, IL
  • NPI 1417033705

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership

Practitioners 1

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.

• Sabeeha Haque Ali, MD

  • Pediatrics Physician
  • Danville, IL
  • NPI 1417033705
  NPD

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

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384214400000",
    "number": "1972937480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 N LOGAN AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618328513",
            "telephone_number": "217-442-5863",
            "fax_number": "217-442-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N LOGAN AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618328513",
            "telephone_number": "217-442-5863",
            "fax_number": "217-442-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SABEEHA HAQUE ALI MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-03",
        "last_updated": "2013-11-12",
        "status": "A",
        "authorized_official_last_name": "HAQUE",
        "authorized_official_first_name": "SABEEHA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "312-545-9727",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "036109029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3426615776045330",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverview Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rural Health Clinic/Center in Danville, IL
• Providers in Danville, IL by specialty
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.