NPIMap

Individual provider Active NPI

Bohdan Fedirko, MD

  • Legal Medicine
  • Chicago, IL
National Provider Identifier
1033163563
Registry record updated Dec 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
036098499 Issued in IL
Practice address
5255 S Cicero Ave
Chicago, IL 60632-4915
Phone
(773) 585-7505
Fax
(773) 585-7507
NPI assigned
May 20, 2006
Last updated
Dec 20, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X 036098499 IL Primary

Addresses

Primary practice location

5255 S Cicero Ave
Chicago, IL 60632-4915

Mailing address

PO Box 388309
Chicago, IL 60638-8309
Phone (773) 585-7505

Other identifiers 1

IdentifierTypeStateIssuer
036098499MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040928000303 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Vascular SurgeryPractitioner - Peripheral Vascular Disease 4789653775 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine, Peripheral Vascular Disease, Vascular Surgery
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5838 S Harlem Ave
Summit, IL 60501-1407
Phone (773) 585-7505

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.9 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
76.32

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Du Page Pathology Associates SC Current Accepting new patients
MD Family Medical Practice LLC CurrentSince May 1, 2021 Accepting new patients
Adventist Midwest Health CurrentSince May 23, 2010 Accepting new patients
Cardiovascular Service Associates CurrentSince Mar 1, 2006 Accepting new patients
Adventist Midwest Health CurrentSince May 23, 2010 Accepting new patients
Adventist Midwest Health Current Accepting new patients

Locations

500 Remington Blvd
Bolingbrook, IL 60440
Phone (630) 312-5000

5255 S Cicero Ave
Chicago, IL 60632
Phone (708) 220-4850

7425 W Irving Park Rd
Chicago, IL 60634
Phone (773) 585-7505

701 Winthrop Ave
Glendale Hts, IL 60139
Phone (630) 312-2000

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

5838 S Harlem Ave
Summit Argo, IL 60501
Phone (773) 585-7505

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1033163563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 388309",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606388309",
            "telephone_number": "773-585-7505",
            "fax_number": "773-585-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5255 S CICERO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606324915",
            "telephone_number": "773-585-7505",
            "fax_number": "773-585-7507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDIRKO",
        "first_name": "BOHDAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "IL",
            "license": "036098499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036098499",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.