Individual provider Active NPI

Elizabeth Anne Dowell, MD

  • Family Medicine Physician
  • Berwyn, IL
National Provider Identifier
1154419661
Registry record updated Dec 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036119747 Issued in IL
Practice address
6201 Roosevelt Rd
Berwyn, IL 60402-1108
Phone
(708) 386-0845
NPI assigned
Oct 10, 2006
Last updated
Dec 30, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2019

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 036119747 IL Primary
Family Medicine Physician 207Q00000X 4301078838 MI

Addresses

Primary practice location

6201 Roosevelt Rd
Berwyn, IL 60402-1108

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other practice location 1

7300 Dexter-Ann Arbor Rd
Dexter, MI 48130
Phone (734) 426-2796

Other identifiers 1

IdentifierTypeStateIssuer
4356637MedicaidMI

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
I20131011001114 IL Practitioner - Family Practice 4486888161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PCC Community Wellness CenterGroup PAC ID 1557270139, 91 clinicians

Practice addresses (Care Compare)

6201 Roosevelt Rd
Berwyn, IL 60402-1108
Phone (708) 386-0845

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301078838MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PCC Community Wellness Center CurrentSince Jul 25, 2013 Accepting new patients
PCC Community Wellness Center CurrentSince Jul 25, 2013 Accepting new patients
PCC Community Wellness Center Past Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

6201 Roosevelt Rd
Berwyn, IL 60402
Phone (708) 386-0845

14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113

Interoperability endpoints

  • Direct secure messaging: elizabeth.dowell.1@13158.direct.athenahealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577664000000",
    "number": "1154419661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6201 ROOSEVELT RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604021108",
            "telephone_number": "708-386-0845"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7300 Dexter-Ann Arbor Rd",
            "address_purpose": "LOCATION",
            "city": "Dexter",
            "state": "MI",
            "postal_code": "48130",
            "country_code": "US",
            "telephone_number": "734-426-2796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOWELL",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036119747",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301078838",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4356637",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

Verify at the official NPI Registry.