Individual provider Active NPI

Arnaud Jean Wautlet, MD

  • Allergy & Immunology Physician
  • Chicago, IL
National Provider Identifier
1184116386
Registry record updated Jun 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
036159272 Issued in IL
Practice address
675 N Saint Clair St
Chicago, IL 60611-5975
Phone
(312) 695-8624
NPI assigned
Jun 4, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 125.072233 IL
Allergy & Immunology Physician 207K00000X 036159272 IL Primary
Internal Medicine Physician 207R00000X 125.072233 IL

Addresses

Primary practice location

675 N Saint Clair St
Chicago, IL 60611-5975

Mailing address

2024 W Iowa St Apt 3
Chicago, IL 60622-5378
Phone (312) 618-3146

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
I20240903000698 IL Practitioner - Allergy/Immunology 8224386693 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
Loyola University of Chicago, Stritch School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

1725 W Harrison St
Suite 117
Chicago, IL 60612-3848
Phone (312) 942-6296

Hospital & facility affiliations

  • Rush University Medical Center Hospital, Chicago, IL, CCN 140119

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.072233ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Center Internal Medicine CurrentSince Sep 1, 2024 Accepting new patients
Rush University Medical Group Internal Medicine CurrentSince Sep 1, 2024 Accepting new patients

Locations

1725 W Harrison St
Ste 117
Chicago, IL 60612
Phone (312) 942-6292

1411 S Michigan Ave
Fl 5
Chicago, IL 60605
Phone (312) 454-2700

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

1645 W Jackson Blvd
Chicago, IL 60612
Phone (312) 942-2200

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1725 W Harrison St
Ste 10
Chicago, IL 60612
Phone (312) 563-3700

1650 W Harrison St
Ste 466
Chicago, IL 60612
Phone (312) 942-0312

Organizations & group practices 2

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 2

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": "1528070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1184116386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 W IOWA ST APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225378",
            "telephone_number": "312-618-3146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115975",
            "telephone_number": "312-695-8624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAUTLET",
        "first_name": "ARNAUD",
        "middle_name": "JEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-04",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125.072233",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "IL",
            "license": "036159272",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.072233",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.