NPIMap

Individual provider Active NPI

Eden D Brandon, MD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1063605814
Registry record updated May 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036095540 Issued in IL
Practice address
10718 S Ewing Ave
Chicago, IL 60617
Phone
(773) 731-5456
Fax
(773) 731-5456
NPI assigned
Aug 24, 2007
Last updated
May 2, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036095540 IL Primary

Addresses

Primary practice location

10718 S Ewing Ave
Chicago, IL 60617

Mailing address

10718 S Ewing Ave
Chicago, IL 60617
Phone (773) 731-5456

Other identifiers 1

IdentifierTypeStateIssuer
P00445820OtherILMEDICARE RAILROAD

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
I20071005000702 IL Practitioner - Internal Medicine 5799870614 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rush Medical College of Rush University, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chandra Diagnostic Cardiology LTDGroup PAC ID 4082509252, 4 clinicians

Practice addresses (Care Compare)

10718 S Ewing Ave
Chicago, IL 60617-6605
Phone (773) 731-5456

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Chandra Diagnostic Cardiology LTD CurrentSince Sep 1, 2007 Accepting new patients
Housecall Physicians Group of Rockford S C Past Accepting new patients

Locations

10718 S Ewing Ave
Chicago, IL 60617
Phone (773) 731-5456

3330 W 177th St
Ste 3E
Hazel Crest, IL 60429
Phone (708) 798-4500

Interoperability endpoints

  • Direct secure messaging: chandradiagnosticcardiology.edenbrandon@131549.advancedmd-direct.com
  • Direct secure messaging: ebrandonmd237156@uchospital.direct-ci.com

Organizations & group practices 2

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 7

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": "1187913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209686400000",
    "number": "1063605814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10718 S EWING AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60617",
            "telephone_number": "773-731-5456",
            "fax_number": "773-731-5456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10718 S EWING AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60617",
            "telephone_number": "773-731-5456",
            "fax_number": "773-731-5456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDON",
        "first_name": "EDEN",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-24",
        "last_updated": "2008-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036095540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00445820",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.