Active NPI
Nils Anderson, M.D.
- Neurology Physician
- Great Lakes, IL
National Provider Identifier
1033109368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 036-108038
- Practice address
- 3001A 6TH St
Dept of Specialty Medicine, Naval Health Clinic
Great Lakes, IL 60088-2811 - Phone
- (847) 688-3444
- Fax
- (847) 688-4487
- NPI assigned
- Oct 27, 2005
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 036-108038 | IL | Primary |
Addresses
Primary practice location
3001A 6TH St
Dept of Specialty Medicine, Naval Health Clinic
Great Lakes, IL 60088-2811
Mailing address
Dept of Specialty Medicine, Naval Health Clinic
3001A Sixth St, BLDG 200H
Great Lakes, IL 60088
Phone (847) 688-3444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130516000638 | IL | Order and Referring Only - Neurology | 0345216727 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-108038 | IL | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033109368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT OF SPECIALTY MEDICINE, NAVAL HEALTH CLINIC",
"address_2": "3001A SIXTH ST, BLDG 200H",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "60088",
"telephone_number": "847-688-3444",
"fax_number": "847-688-4487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001A 6TH ST",
"address_2": "DEPT OF SPECIALTY MEDICINE, NAVAL HEALTH CLINIC",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600882811",
"telephone_number": "847-688-3444",
"fax_number": "847-688-4487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "NILS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "IL",
"license": "036-108038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.