Derrick Anthony Mackavich, D.O.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Practice address

2320 E 93Rd St
Advocate Trinity Hospital
Chicago, IL 60617-3983

Phone

(773) 967-2000

Fax

(773) 967-2000

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Ambulatory Anesthesiologists of Chicago, LLC

  • Anesthesiology Physician
  • Chicago, IL
  • NPI 1659306272
  Medicare reassignment NPD
• Dupage Eye Anesthesiology LLC

  • Anesthesiology Physician
  • Wheaton, IL
  • NPI 1891995916
  Medicare reassignment NPD
• Town Square Anesthesia LLC

  • Anesthesiology Physician
  • Woodstock, IL
  • NPI 1669471017
  Medicare reassignment NPD
• Southeast Anesthesia Consultants LTD

  • Anesthesiology Physician
  • Chicago, IL
  • NPI 1669417440
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1043326317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 W HENDERSON ST # 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572103",
            "telephone_number": "773-327-5058",
            "fax_number": "773-327-5058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 E 93RD ST",
            "address_2": "ADVOCATE TRINITY HOSPITAL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606173983",
            "telephone_number": "773-967-2000",
            "fax_number": "773-967-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKAVICH",
        "first_name": "DERRICK",
        "middle_name": "ANTHONY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110111 1",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHILD OF IL",
            "identifier": "0001620300",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ksenia Mack, PT, DPT
• Lara Mack, PA-C
• Laurin Jarrold Mack, PH.D.
• Mallory Mack
• Shale Mack, MD
• Micheal Patrick Macken, MD
• Ashlee Mackens
• Duncan Marshall Mackenzie
• Erica Mackenzie
• Heather Mackenzie, LICSW, LCSW. CADC

• Anesthesiology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.