AMITHA MADHURI AVASARALA M.D.
NPI 1104388024
General Practice in Maywood, IL

Q: What is Amitha Avasarala's NPI number?

The NPI number for Amitha Avasarala is 1104388024. It was assigned to this individual provider in the NPPES registry on April 1, 2019.

Q: What is Amitha Avasarala's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Amitha Avasarala was last updated on May 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 01, 2019PECOS Enrolled

2160 S 1ST AVE, MAYWOOD, IL 60153(708) 216-5140 Get Directions Write a Review

NPPES record last updated: May 25, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 25, 2023, Apr 1, 2019 (2 updates tracked since 2019).

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About Amitha Madhuri Avasarala M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMITHA MADHURI AVASARALA M.D. (NPI 1104388024) is an individual general practice provider in Maywood, Illinois, licensed in Illinois (036.164758) and active in the NPI registry since April 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104388024

Entity TypeIndividualFemale

Primary Taxonomy208D00000X

Provider Legal NameAMITHA MADHURI AVASARALACredential: M.D.

Location Address2160 S 1ST AVEMaywood, IL 60153-3328

Mailing Address2160 S 1st AveMaywood, IL 60153-3328

Phone(708) 216-5140

Sole ProprietorNo

Enumeration DateApril 1, 2019

Last NPPES UpdateMay 25, 20232 updates tracked since enumeration

NPPES CertifiedMay 25, 2023

✔ NPI 1104388024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in IL · 036.164758

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

2160 S 1ST AVE, Maywood, IL 60153

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amitha Madhuri Avasarala M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANITA OZA NAGAMINE M.D.

Radiology (Diagnostic Radiology)