Medovate LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MEDOVATE LLC

Practice address

1450 Busch Pkwy Ste 145
Buffalo Grove, IL 60089-4541

Phone

(847) 499-5500

NPI assigned

Mar 26, 2018

Last updated

Oct 27, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Mann, MDNPI 1912223322

Title

Owner

Phone

(847) 530-1215

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Skinnovate, LLC

  • Dermatology Physician
  • Munster, IN
  • NPI 1457998692

  0941552277

  Same PAC ID

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David J. Mann, MD

  • Dermatology Physician
  • Buffalo Grove, IL
  • NPI 1912223322
  Medicare reassignment Care Compare group NPD Authorized official
• Sheryl L Hoyer, MD

  • Dermatology Physician
  • Grayslake, IL
  • NPI 1760474928
  Medicare reassignment NPD
• Donovan Kearns, MD

  • Dermatology Physician
  • Des Plaines, IL
  • NPI 1801473624
  Medicare reassignment NPD
• Elizabeth Labuz Noble, M.D.

  • MOHS-Micrographic Surgery Physician
  • Newberry, FL
  • NPI 1568606572

  IL

  Medicare reassignment NPD
• Elizabeth Ann Springer, MD

  • Procedural Dermatology Physician
  • Whiting, IN
  • NPI 1841273513

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666828800000",
    "number": "1053816835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1237 COUNTRY LN",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600154722",
            "telephone_number": "847-530-1215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 BUSCH PKWY STE 145",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600894541",
            "telephone_number": "847-499-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 N Lake Shore Dr Ste 1425",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606114451",
            "country_code": "US",
            "telephone_number": "847-499-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDOVATE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-26",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-530-1215",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "SkinnovateLLC",
            "affiliation": "N",
            "address_1": "1450 Busch Pkwy Ste 145",
            "city": "Buffalo Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600894541",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary McKernan, LCPC
• Dylan McLean, PHARMD
• David L McNeil, M.D.
• Medicose Home Healthcare SVS,Inc
• Mediderm Inc. (MedidermRx)
• Medtec Medical Inc
• Medyssey USA Inc
• Anuj Kamlesh Mehta
• Hetalben Ashish Mehta
• Melina Mehta

• Multi-Specialty Clinic/Center in Buffalo Grove, IL
• Providers in Buffalo Grove, IL by specialty
• Multi-Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.