Individual provider Active NPI

Milena Ivanova, M.D.

  • Diagnostic Radiology Physician
  • Maywood, IL
National Provider Identifier
1174724264
Registry record updated May 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036139052 Issued in IL
Practice address
2160 S 1St Ave
Maywood, IL 60153-3328
Phone
(708) 216-9000
NPI assigned
May 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X D74734 MD
Diagnostic Radiology Physician 2085R0202X 257386 MA
Diagnostic Radiology Physician 2085R0202X 66154 WI
Diagnostic Radiology Physician 2085R0202X 036139052 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Maywood, IL 60153-3328

Mailing address

2160 S 1St Ave
Maywood, IL 60153-3328
Phone (708) 216-9000

Other identifiers 2

IdentifierTypeStateIssuer
058302200MedicaidMD
1174724264MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mivanova142243@direct.luhs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20151111001343 IL Practitioner - Diagnostic Radiology 5395993620 Reassigns benefits to 3 organizations
I20161005002048 WI Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 5395993620 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Miami, LM Miller School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Loyola University Medical CenterGroup PAC ID 3779488903, 917 clinicians

Practice addresses (Care Compare)

2160 S 1St Ave
Maywood, IL 60153-3328
Phone (708) 216-9000

Hospital & facility affiliations

  • Loyola University Medical Center Hospital, Maywood, IL, CCN 140276
  • Loyola Gottlieb Memorial Hospital Hospital, Melrose Park, IL, CCN 140008
  • Macneal Hospital Hospital, Berwyn, IL, CCN 140054

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D74734MDMDDiagnostic Radiology Physician
66154WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center CurrentSince Jul 1, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2020 Accepting new patients
DRS. Massaro & Kalenak S C Current Accepting new patients
City of Hope Medical Group of Illinois PLLC CurrentSince Oct 1, 2015 Accepting new patients
Loyola University Medical Center CurrentSince Jul 1, 2021 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Oct 1, 2016 Accepting new patients
Loyola University Medical Center Current Accepting new patients
Northwestern Medical Faculty Foundation Diagnostic Radiology CurrentSince Sep 1, 2020 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Oct 1, 2016 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Oct 1, 2016 Accepting new patients
Johns Hopkins University Diagnostic Radiology Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

2361 Paysphere Cir
Chicago, IL 60674
Phone (847) 746-4358

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

500 W Court St
Kankakee, IL 60901
Phone (800) 585-4119

1000 N Westmoreland Rd
Lake Forest, IL 60045
Phone (847) 535-6150

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

1000 N Westmoreland Rd
Fl 3
Lake Forest, IL 60045
Phone (847) 535-6615

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

2520 Elisha Ave
Zion, IL 60099
Phone (800) 322-9183

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

1700 W Paradise Dr
West Bend, WI 53095
Phone (262) 334-3451

Organizations & group practices 11

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": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653091200000",
    "number": "1174724264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANOVA",
        "first_name": "MILENA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-29",
        "last_updated": "2022-05-21",
        "certification_date": "2022-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "D74734",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "257386",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "66154",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036139052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058302200",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174724264",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mivanova142243@direct.luhs.org",
            "affiliation": "N",
            "endpointDescription": "mivanova142243@direct.luhs.org",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2160 S 1st Ave",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601533328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.