DR. RISHA RAVEN FENNELL (MD) – Addiction Medicine (Family Medicine) Physician, NPI 1487622379
Addiction Medicine (Family Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
101 ADDICTION MEDICINE in IL
Provider Addresses for DR. RISHA RAVEN FENNELL (MD)
1096 1350th St
Lincoln, IL 626565094
Phone: (217) 735-5581
Type: Location
900 BEECH ST
NORMAL, IL 617611803
Phone: (779) 429-2227
Type: Mailing
2501 CHATHAM RD STE 4713
SPRINGFIELD, IL 627044188
Phone: (779) 429-2227
Type: Location
1096 1350TH ST
LINCOLN, IL 626565094
Phone: (217) 735-5581
Type: Location
Carle Foundation Hospital, 611, West Park Street, Urbana, Champaign County, Illinois, 61801, United States
FAPC
URBANA, IL 61801
Phone:
Type: Mailing
1302, Franklin Avenue, Normal, McLean County, Illinois, 61701, United States
NORMAL, IL 617613551
Phone: (309) 268-5620
Type: Location
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: 2010-12-01
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20101201001278 | I | Addiction Medicine | IL | 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 62656)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | IL | |
| Clinical Social Worker | IL | |
| Physician Assistant | IL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | IL | |
| - | IL | |
| Pediatric Medicine | IL | |
| P O D I A T R Y | IL | |
| Internal Medicine | IL | |
| - | IL | |
| Internal Medicine | IL |
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