PUSHPA K MAMTANI (MD) – Pediatrics Physician, NPI 1376527168
Pediatrics Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
1,158 PEDIATRIC MEDICINE in IL
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Provider Addresses for PUSHPA K MAMTANI (MD)
1614, East Norris Drive, Ottawa, LaSalle County, Illinois, 61350, United States
OTTAWA, IL 613503681
Phone: (815) 433-1010
Fax: (815) 433-0067
Type: Mailing
1614 E Norris Dr
Ottawa, IL 613503681
Phone: (815) 433-1010
Fax: (815) 433-0067
Type: Location
5666 E STATE ST
ROCKFORD, IL 611082425
Phone: (815) 226-2000
Type: Location
601 JOHN ST STE M-352
KALAMAZOO, MI 490075341
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-12-18
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050203000349 | I | Pediatric Medicine | IL | TBD |
| I20251218000826 | I | Pediatric Medicine | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 61350)
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