Individual provider Active NPI

Kurt W Erickson, M.D.

  • Interventional Cardiology Physician
  • Merrionette Park, IL
National Provider Identifier
1033173125
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
036073183 Issued in IL
Practice address
11560 S Kedzie Ave Ste 100
Merrionette Park, IL 60803-4517
Phone
(708) 824-1114
Fax
(708) 824-9341
NPI assigned
Apr 14, 2006
Last updated
Dec 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036073183 IL
Interventional Cardiology Physician 207RI0011X 036073183 IL Primary

Addresses

Primary practice location

11560 S Kedzie Ave Ste 100
Merrionette Park, IL 60803-4517

Mailing address

13011 S 104TH Ave Ste 100
Palos Park, IL 60464-1508
Phone (708) 478-3600

Other practice location 1

2338 New St
Blue Island, IL 60406-2402
Phone (708) 824-1114

Other practice location 2

13011 S 104th Ave Ste 100
Palos Park, IL 60464-1508
Phone (708) 274-3278

Other practice location 3

3231 Euclid Ave Ste 201
Berwyn, IL 60402-3472
Phone (708) 783-2055

Other identifiers 10

IdentifierTypeStateIssuer
236550OtherILMEDICARE GROUP
060042344OtherILRAILROAD MEDICARE COOK
416810OtherILMEDICARE GROUP
CD8033OtherILRAILROAD MEDICARE GROUP PTAN NUMBER
060056644OtherILRAILROAD MEDICARE WILL
01621208OtherBLUE CROSS BLUE SHIELD
236551OtherILMEDICARE GROUP
CN2703OtherILRAILROAD MEDICARE GROUP PTAN NUMBER
1508810086OtherILGROUP NPI
036073183MedicaidIL

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address kerickson-sm@heartcc.com
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address kerickson276237@direct.myadvocateaurora.org

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
I20040501000104 IL Practitioner - Interventional CardiologyPractitioner - Other (Physician)Practitioner - Cardiovascular Disease (Cardiology) 2466364013 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11560 S Kedzie Ave
Suite 102
Merrionette Park, IL 60803-4517

13011 S 104TH Ave
Suite 100
Palos Park, IL 60464-1508

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting21
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036073183ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gottlieb Community Health Services Corporation CurrentSince Aug 15, 2018 Accepting new patients
Premier Vascular, LLC Cardiovascular Disease CurrentSince Jan 4, 2019 Accepting new patients
Heart Care Centers of Illinois, SC Cardiovascular Disease CurrentSince Aug 1, 1997 Accepting new patients
Gottlieb Community Health Services Corporation CurrentSince Aug 15, 2018 Accepting new patients
Heart Care Centers of Illinois, SC Cardiovascular Disease Past Accepting new patients
Uropartners, LLC Past Accepting new patients

Locations

3231 Euclid Ave
Ste 201
Berwyn, IL 60402
Phone (708) 783-2055

3231 Euclid Ave
Ste 400
Berwyn, IL 60402
Phone (708) 478-3600

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

2338 New St
Blue Island, IL 60406
Phone (708) 577-5060

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

2121 Oneida St
Ste 202
Joliet, IL 60435
Phone (815) 741-4390

125 N La Grange Rd
La Grange, IL 60525
Phone (708) 354-4900

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

11560 S Kedzie Ave
#102
Merrionette Park, IL 60803

11560 S Kedzie Ave
Ste 100
Merrionette Park, IL 60803
Phone (708) 371-3105

11560 S Kedzie Ave
Ste 102
Merrionette Park, IL 60803
Phone (708) 972-7520

10260 191st St
Ste 102
Mokena, IL 60448
Phone (708) 478-4224

4440 W 95th St
Oak Lawn, IL 60453
Phone (708) 346-5520

13011 S 104th Ave
Ste 100
Palos Park, IL 60464
Phone (708) 274-3278

3722 Harlem Ave
Ste 101
Riverside, IL 60546
Phone (708) 783-6500

Interoperability endpoints

  • Direct secure messaging: kerickson-sm@heartcc.com
  • Direct secure messaging: kerickson276237@direct.myadvocateaurora.org

Organizations & group practices 6

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 5

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": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1033173125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13011 S 104TH AVE STE 100",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604641508",
            "telephone_number": "708-478-3600",
            "fax_number": "708-478-3552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11560 S KEDZIE AVE STE 100",
            "city": "MERRIONETTE PARK",
            "state": "IL",
            "postal_code": "608034517",
            "telephone_number": "708-824-1114",
            "fax_number": "708-824-9341"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2338 New St",
            "address_purpose": "LOCATION",
            "city": "Blue Island",
            "state": "IL",
            "postal_code": "604062402",
            "country_code": "US",
            "telephone_number": "708-824-1114",
            "fax_number": "708-824-9341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13011 S 104th Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Palos Park",
            "state": "IL",
            "postal_code": "604641508",
            "country_code": "US",
            "telephone_number": "708-274-3278",
            "fax_number": "708-274-3299",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3231 Euclid Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Berwyn",
            "state": "IL",
            "postal_code": "604023472",
            "country_code": "US",
            "telephone_number": "708-783-2055",
            "fax_number": "708-783-2181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "KURT",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036073183",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "036073183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "236550",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE COOK",
            "identifier": "060042344",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "416810",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP PTAN NUMBER",
            "identifier": "CD8033",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE WILL",
            "identifier": "060056644",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01621208",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "236551",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP PTAN NUMBER",
            "identifier": "CN2703",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1508810086",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036073183",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kerickson-sm@heartcc.com",
            "affiliation": "N",
            "address_1": "13011 S 104th Ave Ste 100",
            "city": "Palos Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604641508",
            "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": "4440 W 95th St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kerickson276237@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "4440 W 95th St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Merrionette Park, IL

Sources for this page

Verify at the official NPI Registry.