North Shore Urogynecology LTD
Organization Active NPI Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician · Park City, IL
NPI 1013021922 · NPPES record last updated Dec 18, 2021
Key facts
- NPI
- 1013021922
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X
- License
- 036-101308 (IL)
- Legal business name
- NORTH SHORE UROGYNECOLOGY LTD
- Practice address
- 351 Greenleaf Ave
E
Park City, IL 60085-5701 - Phone
- (847) 234-1100
- Fax
- (847) 775-0703
- NPI assigned
- Aug 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Sanjay Gandhi, M.D.
- Title
- President
- Phone
- (847) 234-1100
Practitioners 12
-
Sanjay Gandhi, M.D.
-
Samata J Shroff, PA-C
-
Rosalind F Sharain, M.D.
-
Jie Song, M.D.
-
Shiwen Song, MD
-
Kimiko Suzue, M.D.
-
Michael P Viglione, MD PHD
-
David Phillip Arps, M.D.
-
Kristen Michelle Paral, M.D.
-
Timothy Leonor Tan, D.O.
-
James Edward Jupa, M.D.,
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1056847 | North Shore Urogynecology, LTD | Compliance | Oct 30, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050314000959 | IL | Part B Supplier - Clinic/Group Practice | 9638124571 |
Receives reassigned benefits from 11 practitioners Practice locations: Chicago, IL; Woodstock, IL; Waukegan, IL; Park City, IL; McHenry, IL; Lindenhurst, IL; Libertyville, IL; Lake Villa, IL… |
National Provider Directory
Locations
7435 W Talcott Ave
Ste 507
Chicago, IL 60631
660 N Westmoreland Rd
#306
Lake Forest, IL 60045
Phone (847) 615-5419
1105 W Park Ave
Ste 6
Libertyville, IL 60048
145 N Milwaukee Ave
Vernon Hills, IL 60061
Phone (847) 226-0267
3703 Doty Rd
Woodstock, IL 60098
Phone (815) 334-3170
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BCHJAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician |
207VF0040X | 036-101308 | IL | Yes |
| Gynecology Physician |
207VG0400X | 036101308 | IL | |
| Urology Physician |
208800000X | 036101308 | IL |
Addresses
Primary practice location
351 Greenleaf Ave
E
Park City, IL 60085-5701
Mailing address
351 Greenleaf Ave
E
Park City, IL 60085-5701
Phone (847) 234-1100
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sanjay.gandhi@nsu.eclinicaldirect.com | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ | Direct | |
| Direct Messaging Address | sgandhi235674@direct.myadvocateaurora.org | Direct |
Other providers in Park City, IL
- Lake Shore Dermatology, LTD.
- Sheila Varghese Maliekel
- Milagros Galvez DDS PC
- David R. Mortensen
- Michael Nguyen
- Omnidoc Health Inc
- Rhutav J Parikh
- Podiatry & Sports Medicine Associates P.C.
- Peter Joseph Puthenveetil
- Olivia Reyes
All providers in Park City, IL · Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.