Individual provider Active NPI

Paul Anthony Ravenna, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1124381769
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036136981 Issued in IL
Practice address
1333 W Belmont Ave
Northwestern Medicine
Chicago, IL 60657-5785
Phone
(312) 972-5115
NPI assigned
Jun 19, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036136981 IL Primary

Addresses

Primary practice location

1333 W Belmont Ave
Northwestern Medicine
Chicago, IL 60657-5785

Mailing address

680 N Lake Shore Dr
Suite 1000
Chicago, IL 60611-4546

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
I20150715000815 IL Practitioner - Family Practice 5890008163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

1333 W Belmont Ave
Chicago, IL 60657-5785

1475 E Belvidere Rd
Grayslake, IL 60030-2012

4445 W Irving Park Rd
Chicago, IL 60641-2808

660 N Westmoreland Rd
302 Lake Forest OBGYN
Lake Forest, IL 60045-1673
Phone (312) 926-6146

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jul 30, 2015 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 30, 2015 Accepting new patients
Central Dupage Physician Group Family Medicine Past Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

1333 W Belmont Ave
Ste 100
Chicago, IL 60657
Phone (312) 693-2273

1333 W Belmont Ave
Ste 200
Chicago, IL 60657
Phone (773) 248-5009

1333 W Belmont Ave
Chicago, IL 60657
Phone (312) 694-2273

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

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.

Hospital & facility affiliations 4

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": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435708800000",
    "number": "1124381769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 N LAKE SHORE DR",
            "address_2": "SUITE 1000",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 W BELMONT AVE",
            "address_2": "NORTHWESTERN MEDICINE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575785",
            "telephone_number": "312-972-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVENNA",
        "first_name": "PAUL",
        "middle_name": "ANTHONY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-19",
        "last_updated": "2015-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036136981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.