Individual provider Active NPI

Anel Yakupovich, MD

  • Vascular & Interventional Radiology Physician
  • Chicago, IL
National Provider Identifier
1164928446
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
036.156399 Issued in IL
Practice address
1653 W Congress Pkwy
Chicago, IL 60612-3833
Phone
(312) 942-6510
NPI assigned
Apr 4, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X A194677 CA
Student in an Organized Health Care Education/Training Program 390200000X
Vascular & Interventional Radiology Physician 2085R0204X 036.156399 IL Primary

Addresses

Primary practice location

1653 W Congress Pkwy
Chicago, IL 60612-3833

Mailing address

600 S Paulina St
Chicago, IL 60612-3806

Other practice location 1

39000 Bob Hope Dr
Rancho Mirage, CA 92270-3221
Phone (760) 674-3850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240802001773 CA Practitioner - Diagnostic Radiology 9537414933 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Rush Medical College of Rush University, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palm Desert Radiology Medical Group IncGroup PAC ID 0749173789, 125 clinicians

Practice addresses (Care Compare)

73978 Van Gogh Dr
Palm Desert, CA 92211-4524
Phone (844) 825-9300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.08 of 100Reported as group
Quality
81.28
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A194677CAMDVascular & Interventional Radiology Physician
036.156399ILMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Palm Desert Radiology Medical Group, Inc CurrentSince May 20, 2024 Accepting new patients
Rush University Medical Group Past Accepting new patients
Eisenhower Medical Center Past Accepting new patients

Locations

45280 Seeley Dr
Ste 100A
La Quinta, CA 92253

151 S Sunrise Way
Ste 400
Palm Springs, CA 92262
Phone (760) 674-3583

70390 Highway 111
Rancho Mirage, CA 92270

70380 Highway 111
Rancho Mirage, CA 92270

39000 Bob Hope Dr
Rancho Mirage, CA 92270
Phone (760) 340-3911

39000 Bob Hope Dr
Ste 310
Rancho Mirage, CA 92270

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 1

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": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1164928446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S PAULINA ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 W CONGRESS PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123833",
            "telephone_number": "312-942-6510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39000 Bob Hope Dr",
            "address_purpose": "LOCATION",
            "city": "Rancho Mirage",
            "state": "CA",
            "postal_code": "922703221",
            "country_code": "US",
            "telephone_number": "760-674-3850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YAKUPOVICH",
        "first_name": "ANEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-04",
        "last_updated": "2024-03-28",
        "certification_date": "2024-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CA",
            "license": "A194677",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IL",
            "license": "036.156399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.