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DR. PAVANA SREENIVASAN M.D.
NPI 1669905113
Pediatrics - Pediatric Critical Care Medicine in Peoria, IL

Active since April 11, 2017PECOS EnrolledAccepts Medicare Assignment
530 NE GLEN OAK AVE, PEORIA, IL 61637(309) 624-0716 Get Directions Write a Review

NPPES record last updated: September 13, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 15, 2020, Sep 11, 2017, Apr 11, 2017 (3 updates tracked since 2017).

About Dr. Pavana Sreenivasan M.d. NPPES

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

DR. PAVANA SREENIVASAN M.D. (NPI 1669905113) is an individual pediatric critical care medicine provider in Peoria, Illinois, licensed in Illinois (036.164817) and active in the NPI registry since April 2017. She is enrolled in Medicare PECOS and is a graduate of Other (2015).

NPPES Registry Identity

NPI1669905113
Entity TypeIndividualFemale
Primary Taxonomy2080P0203X
Provider Legal NameDR. PAVANA SREENIVASANCredential: M.D.
Location Address530 NE GLEN OAK AVEPeoria, IL 61637-0001
Mailing Address1201 W La Veta AveOrange, CA 92868-4203
Phone(309) 624-0716
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateApril 11, 2017
Last NPPES UpdateSeptember 13, 20233 updates tracked since enumeration
NPPES CertifiedSeptember 12, 2023
✔ NPI 1669905113 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric Critical Care MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080P0203X
License✔ Licensed in IL · 036.164817
Definition
A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
530 NE GLEN OAK AVE, Peoria, IL 61637
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Pavana Sreenivasan M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8224394192
PECOS Enrollment IDI20230808001553
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.

Medicare Billing Reassignment

Medicare enrollment records show Pavana Sreenivasan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Board Of Trustees Of The University Of Illinois
0.6 mi
Pediatrics
1 ILLINI DR
Peoria, IL 61605
  • Reassigned Medicare billing, Illinois enrollment
  • 2,127 clinicians in this Medicare group
NPI 1467425322 (309) 680-8649

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

DR. HAMID MAHMOOD ZIA M.D
Pathology (Anatomic Pathology & Clinical Pathology)
530 NE GLEN OAK AVE, CENTRAL ILLINOIS PATHOLOGY SC
PEORIA, IL 61637
Peoria County (309) 624-9011
THOMAS JAMES MCMORROW MD
Pediatrics
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2553
ALEXANDRA ROPER MD
Surgery
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
JAPMEHR KAUR SANDHU M.B.B.S.
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 624-9351
THOMAS BLACKWELL JR. MD
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
LUKE KLOFT
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2109
ABIGAIL V. WELU DO
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-6710
DR. JAMES DANIEL DEWAR D.O.
Internal Medicine (Interventional Cardiology)
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-7257

Frequently 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 Pavana Sreenivasan's NPI number?

The NPI number for Pavana Sreenivasan is 1669905113. It was assigned to this individual provider in the NPPES registry on April 11, 2017.

Where is Pavana Sreenivasan located?

Pavana Sreenivasan practices at 530 NE Glen Oak Ave, Peoria, IL 61637. The listed phone number is (309) 624-0716.

What is Pavana Sreenivasan's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Critical Care Medicine, with taxonomy code 2080P0203X.

Is Pavana Sreenivasan enrolled in Medicare?

Yes. Pavana Sreenivasan is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Pavana Sreenivasan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Pavana Sreenivasan reassigns Medicare benefits to Board Of Trustees Of The University Of Illinois (Peoria, IL). The 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 Pavana Sreenivasan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Pavana Sreenivasan was last updated on September 13, 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.