Individual provider Active NPI

Dean A Raffaelli, D.O.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1174557532
Registry record updated Jul 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36100488 Issued in IL
Practice address
47 W Polk St
Chicago, IL 60605-2000
Phone
(312) 922-3011
Fax
(312) 922-5860
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2008

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 36100488 IL Primary

Addresses

Primary practice location

47 W Polk St
Chicago, IL 60605-2000

Mailing address

47 W Polk St
Chicago, IL 60605-2000
Phone (312) 922-3011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36100488ILMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217462400000",
    "number": "1174557532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 W POLK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052000",
            "telephone_number": "312-922-3011",
            "fax_number": "312-922-5860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 W POLK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052000",
            "telephone_number": "312-922-3011",
            "fax_number": "312-922-5860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAFFAELLI",
        "first_name": "DEAN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2008-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36100488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.