Individual provider Active NPI

Sandy Kwak, MD

  • Diagnostic Radiology Physician
  • Aurora, IL
National Provider Identifier
1033148291
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036090107 Issued in IL
Practice address
1221 N Highland Ave
Aurora, IL 60506-1404
Phone
(630) 859-8700
Fax
(630) 264-8428
NPI assigned
Jul 1, 2006
Last updated
Dec 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036090107 IL Primary

Addresses

Primary practice location

1221 N Highland Ave
Aurora, IL 60506-1404

Mailing address

1870 W Galena Blvd
Aurora, IL 60506-4356
Phone (630) 859-6700

Other identifiers 1

IdentifierTypeStateIssuer
04515143OtherILBCBS ID#

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address skwak206885@direct.myadvocateaurora.org Direct
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050609000993 IL Practitioner - Diagnostic Radiology 4587607536 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036090107ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Nov 1, 2002 Accepting new patients
Aurora Radiology Consultants, S.C. Diagnostic Radiology CurrentSince Mar 15, 2009 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Nov 1, 2002 Accepting new patients
Integrated Imaging Consultants LLC Diagnostic Radiology CurrentSince Jul 1, 2016 Accepting new patients
Central Dupage Physician Group Past Accepting new patients
Valley Imaging Consultants, LLC Diagnostic Radiology Past Accepting new patients

Locations

1221 N Highland Ave
Aurora, IL 60506
Phone (630) 859-6700

1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756

1870 W Galena Blvd
Aurora, IL 60506
Phone (630) 859-6700

2357 Sequoia Dr
Aurora, IL 60506
Phone (630) 859-6700

28594 Network Pl
Chicago, IL 60673

1420 Renaissance Dr
Ste 307
Park Ridge, IL 60068
Phone (847) 803-1000

1775 W Dempster St
Park Ridge, IL 60068
Phone (847) 723-5150

Interoperability endpoints

  • Direct secure messaging: skwak206885@direct.myadvocateaurora.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1033148291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 W GALENA BLVD",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605064356",
            "telephone_number": "630-859-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 N HIGHLAND AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605061404",
            "telephone_number": "630-859-8700",
            "fax_number": "630-264-8428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "SANDY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036090107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID#",
            "identifier": "04515143",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skwak206885@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1221 N Highland Ave",
            "city": "Aurora",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605061404",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1221 N Highland Ave",
            "city": "Aurora",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605061404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

Verify at the official NPI Registry.