Individual provider Active NPI

Jill Christina Anderson, M.D.

  • Dermatology Physician
  • Evanston, IL
National Provider Identifier
1205063781
Registry record updated Mar 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036.132244 Issued in IL
Practice address
1704 Maple Ave
Suite 200
Evanston, IL 60201-3134
Phone
(847) 926-0106
Fax
(312) 694-0202
NPI assigned
Jun 11, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 036.132244 IL Primary

Addresses

Primary practice location

1704 Maple Ave
Suite 200
Evanston, IL 60201-3134

Mailing address

1704 Maple Ave
Suite 200
Evanston, IL 60201-3134
Phone (847) 926-0106

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
I20131031000518 IL Practitioner - Dermatology 7113152018 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Rush Medical College of Rush University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

675 N St Clair
250 Dept Gastro Endo Sgy
Chicago, IL 60611-5975
Phone (312) 695-8918

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions463
Removal or shaving of skin growth12
Skin biopsy271

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.132244ILMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2014 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2014 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

1460 N Halsted St
Ste 504
Chicago, IL 60642
Phone (312) 694-1097

111 W Washington St
Ste 1801
Chicago, IL 60602
Phone (312) 726-8800

1704 Maple Ave
Ste 200
Evanston, IL 60201
Phone (847) 535-8500

1630 Sherman Ave
Ste 200
Evanston, IL 60201
Phone (847) 534-3278

660 N Westmoreland Rd
Lake Forest, IL 60045
Phone (847) 535-6100

800 N Westmoreland Rd
Ste 201
Lake Forest, IL 60045
Phone (847) 388-0603

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 3

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": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458259200000",
    "number": "1205063781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 MAPLE AVE",
            "address_2": "SUITE 200",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013134",
            "telephone_number": "847-926-0106",
            "fax_number": "312-694-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 MAPLE AVE",
            "address_2": "SUITE 200",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013134",
            "telephone_number": "847-926-0106",
            "fax_number": "312-694-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JILL",
        "middle_name": "CHRISTINA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-11",
        "last_updated": "2016-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036.132244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.