Individual provider Active NPI

Andrey Leonov, M.D.

  • Allergy & Immunology Physician
  • Joliet, IL
National Provider Identifier
1043310261
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
036-125826 Issued in IL
Practice address
2100 Glenwood Ave
Joliet, IL 60435-5487
Phone
(815) 514-2712
NPI assigned
Sep 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 248493 NY
Pediatrics Physician 208000000X 35089736 OH
Pediatrics Physician 208000000X 25MA08039700 NJ
Pediatric Allergy/Immunology Physician 2080P0201X 4301107932 MI
Allergy & Immunology Physician 207K00000X 036-125826 IL Primary

Addresses

Primary practice location

2100 Glenwood Ave
Joliet, IL 60435-5487

Mailing address

PO Box 713260
Chicago, IL 60677-1260
Phone (630) 469-2000

Other identifiers 1

IdentifierTypeStateIssuer
2745373MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aleonov178312@direct.edward.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
I20101103001240 IL Practitioner - Allergy/Immunology 4284720558 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dupage Medical Group LTDGroup PAC ID 5496667941, 1,326 clinicians

Practice addresses (Care Compare)

2100 Glenwood Ave
Joliet, IL 60435-5487
Phone (815) 725-2121

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-125826ILMDAllergy & Immunology Physician
25MA08039700NJMDPediatrics Physician
248493NYMDPediatrics Physician
4301107932MIMDPediatric Allergy/Immunology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dupage Medical Group LTD CurrentSince Jun 4, 2018 Accepting new patients
Dupage Medical Group LTD CurrentSince Jun 4, 2018 Accepting new patients
Michigan State University Kalamazoo Center for Medical Studies Past Accepting new patients

Locations

30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210

1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000

2100 Glenwood Ave
Joliet, IL 60435
Phone (815) 999-3201

301 Madison St
Ste 207
Joliet, IL 60435

Interoperability endpoints

  • Direct secure messaging: aleonov178312@dulyhealthandcare.direct-ci.com
  • Direct secure messaging: aleonov178312@direct.edward.org

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1043310261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771260",
            "telephone_number": "630-469-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 GLENWOOD AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604355487",
            "telephone_number": "815-514-2712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEONOV",
        "first_name": "ANDREY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "248493",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35089736",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA08039700",
            "primary": false
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "MI",
            "license": "4301107932",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "IL",
            "license": "036-125826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2745373",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aleonov178312@direct.edward.org",
            "affiliation": "N",
            "address_1": "2100 Glenwood Ave",
            "city": "Joliet",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604355487",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.