Active NPI
Michael Boehmer Pine, M.D.
- Cardiovascular Disease Physician
- Evanston, IL
National Provider Identifier
1184853558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 036075448
- Practice address
- 1210 Chicago Ave
Ste 503
Evanston, IL 60202-6515 - Phone
- (847) 492-0162
- Fax
- (847) 492-8130
- NPI assigned
- Jul 7, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 036075448 | IL | Primary |
Addresses
Primary practice location
1210 Chicago Ave
Ste 503
Evanston, IL 60202-6515
Mailing address
1210 Chicago Ave
Ste 503
Evanston, IL 60202-6515
Phone (847) 492-0162
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036075448 | IL | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246924800000",
"number": "1184853558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 CHICAGO AVE",
"address_2": "STE 503",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602026515",
"telephone_number": "847-492-0162",
"fax_number": "847-492-8130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1210 CHICAGO AVE",
"address_2": "STE 503",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602026515",
"telephone_number": "847-492-0162",
"fax_number": "847-492-8130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PINE",
"first_name": "MICHAEL",
"middle_name": "BOEHMER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-07",
"last_updated": "2009-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "IL",
"license": "036075448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.