Individual provider Active NPI

Severyn Yaroshevsky, MD

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1205835287
Registry record updated May 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036110134 Issued in IL
Practice address
8012 S Crandon
Chicago, IL 60617-1124
Phone
(773) 731-9000
Fax
(773) 731-9622
NPI assigned
Jul 20, 2005
Last updated
May 17, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 17, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036110134 IL Primary

Addresses

Primary practice location

8012 S Crandon
Chicago, IL 60617-1124

Mailing address

611 S. Wells Street #2701
Chicago, IL 60607-4782
Phone (312) 493-1219

Other identifiers 1

IdentifierTypeStateIssuer
036110134MedicaidIL

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
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
97.64 of 100Reported as group
Quality
88.52
Promoting interoperability
100
Improvement activities
40
Cost
86.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036110134ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Shore Hospital Corporation Family Medicine CurrentSince Nov 1, 2008 Accepting new patients
Louisiana State University School of Medicine in New Orleans Faculty G CurrentSince Feb 1, 2018 Accepting new patients
Louisiana State University School of Medicine in New Orleans Faculty G CurrentSince Feb 1, 2018 Accepting new patients
DHS/Office of Financial Services Irs/Eopc/BMRC/Eotc/Osh/Osh-P CurrentSince Mar 8, 2022 Accepting new patients
Lallie Kemp Medical Ctr CurrentSince Jan 3, 2023 Accepting new patients
Lallie Kemp Medical Ctr CurrentSince Jan 3, 2023 Accepting new patients

Locations

8012 S Crandon Ave
Chicago, IL 60617
Phone (773) 356-5000

52579 Highway 51 S
Independence, LA 70443
Phone (985) 878-1349

200 W Esplanade Ave
Kenner, LA 70065
Phone (504) 464-2940

200 W Esplanade Ave
Ste 41
Kenner, LA 70065
Phone (504) 464-2940

200 W Esplanade Ave
Ste 412
Kenner, LA 70065
Phone (504) 464-2940

1542 Tulane Ave
New Orleans, LA 70112
Phone (504) 866-2741

2025 Gravier St
Fl 6
New Orleans, LA 70112

2832 Burdette St
New Orleans, LA 70125
Phone (504) 866-2741

2600 Center St NE
Salem, OR 97301
Phone (503) 945-2800

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274054400000",
    "number": "1205835287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 S. WELLS STREET #2701",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074782",
            "telephone_number": "312-493-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8012 S CRANDON",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606171124",
            "telephone_number": "773-731-9000",
            "fax_number": "773-731-9622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAROSHEVSKY",
        "first_name": "SEVERYN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2010-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036110134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110134",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.