RIVER VALLEY MEDICAL GROUP, LLC
NPI 1396408290
Internal Medicine in Davenport, IA
About River Valley Medical Group, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RIVER VALLEY MEDICAL GROUP, LLC (NPI 1396408290) is a healthcare organization registered as an internal medicine in Davenport, Iowa and active in the NPI registry since October 2021. The organization holds a CLIA Waiver certificate valid through February 24, 2028 and lists Radhika N Kolla, Physician/owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
River Valley Medical Group, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to River Valley Medical Group, LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.
Clinicians, nearest first (3)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 16D2253885
River Valley Medical Group · Davenport, IAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is River Valley Medical Group, LLC's NPI number?
The NPI number for River Valley Medical Group, LLC is 1396408290. It was assigned to this organization in the NPPES registry on October 18, 2021.
Where is River Valley Medical Group, LLC located?
River Valley Medical Group, LLC is located at 4626 Progress Dr Ste C, Davenport, IA 52807. The listed phone number is (563) 551-4200.
What is River Valley Medical Group, LLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is River Valley Medical Group, LLC enrolled in Medicare?
Yes. River Valley Medical Group, LLC is registered in the Medicare PECOS enrollment system.
When is River Valley Medical Group, LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Iowa, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through River Valley Medical Group, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to River Valley Medical Group, LLC, in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does River Valley Medical Group, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 16D2253885) is associated with this NPI, valid through February 24, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for River Valley Medical Group, LLC was last updated on June 23, 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.
# River Valley Medical Group, Llc · NPI 1396408290
Internal Medicine organization in Davenport, Iowa. Organization record, active in the CMS NPPES registry since October 18, 2021.
## Identity
- **NPI:** 1396408290 (Entity type: Organization)
- **Enumerated:** October 18, 2021
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Radhika Kolla, PHYSICIAN/OWNER
## Practice location
- **Address:** 4626 PROGRESS DR STE C, Davenport, IA 52807-3485
- **Phone:** (563) 551-4200 · **Fax:** (563) 441-9101
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Iowa, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 3 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (2), Internal Medicine (1); 3 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 23, 2023
- **Other identifiers:** Other G81285; Medicaid 1598744096 (IA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1396408290) · Data from the CMS NPPES public registry.