NPIMap

Individual provider Active NPI

Peyman Pahlavan, M.D.

  • Family Medicine Physician
  • Melrose Park, IL
National Provider Identifier
1063450757
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036103944 Issued in IL
Practice address
153 1/2 N. Broadway Avenue
Melrose Park, IL 60160
Phone
(708) 345-8960
Fax
(708) 345-8965
NPI assigned
Jun 3, 2006
Last updated
May 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036103944 IL Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 036-103944 IL

Addresses

Primary practice location

153 1/2 N. Broadway Avenue
Melrose Park, IL 60160

Mailing address

153 1/2 Broadway Ave
Melrose Park, IL 60160
Phone (312) 371-9325

Other identifiers 2

IdentifierTypeStateIssuer
0001634278OtherILBLUE CROSS & BLUE SHIELD
036-103944MedicaidIL

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
I20031217000598 IL Practitioner - Internal MedicinePractitioner - General PracticePractitioner - Geriatric Medicine 1658278619 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

153 /2 N Broadway Ave
Melrose Park, IL 60160-3702
Phone (708) 345-8960

4009 Warren Ave
Bellwood, IL 60104-2066
Phone (708) 343-1300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-103944ILMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Broadway Medical Center Family Medicine CurrentSince May 1, 2006 Accepting new patients
Hias Diagnostics Inc Past Accepting new patients
Addison Pharmacy, Inc PastSince Apr 7, 2014 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Ultrasound Mobile Service, LTD Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: pahlavan.peyman.003.0130085@bmc.meditab.direct-ci.com

Organizations & group practices 9

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": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1063450757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 1/2 BROADWAY AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "60160",
            "telephone_number": "312-371-9325",
            "fax_number": "708-345-8965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 1/2 N. BROADWAY AVENUE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "60160",
            "telephone_number": "708-345-8960",
            "fax_number": "708-345-8965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAHLAVAN",
        "first_name": "PEYMAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036103944",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036-103944",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "0001634278",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-103944",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose Park, IL

Sources for this page

Verify at the official NPI Registry.