NPIMap

Organization Active NPI

USA Vascular Centers of Chicago, LLC

  • Vascular Surgery Physician
  • Northbrook, IL
National Provider Identifier
1174995674
Registry record updated Oct 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
USA VASCULAR CENTERS OF CHICAGO, LLC
Practice address
4141 Dundee Rd
Suite B
Northbrook, IL 60062-2129
Phone
(847) 593-8460
Fax
(224) 246-8460
NPI assigned
Oct 22, 2015
Last updated
Oct 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2015

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

Authorized official

Name
Yan Katsnelson, MDNPI 1285672840
Title
Director
Phone
(847) 593-8460

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

4141 Dundee Rd
Suite B
Northbrook, IL 60062-2129

Mailing address

4141 Dundee Rd
Northbrook, IL 60062-2129
Phone (847) 593-8460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160531002300 IL Part B Supplier - Clinic/Group Practice 5092005215 Receives reassigned benefits from 20 practitioners
Practice locations: Northbrook, IL

National Provider Directory

National Provider Directory

Locations

4141 Dundee Rd
Ste B
Northbrook, IL 60062

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445472000000",
    "number": "1174995674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 DUNDEE RD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600622129",
            "telephone_number": "847-593-8460",
            "fax_number": "224-246-8460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 DUNDEE RD",
            "address_2": "SUITE B",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600622129",
            "telephone_number": "847-593-8460",
            "fax_number": "224-246-8460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USA VASCULAR CENTERS OF CHICAGO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-22",
        "last_updated": "2015-10-22",
        "status": "A",
        "authorized_official_last_name": "KATSNELSON",
        "authorized_official_first_name": "YAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-593-8460",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.