NPIMap

Individual provider Active NPI

Mikhail Khodarkovskiy, M.D.

  • Family Medicine Physician
  • Mundelein, IL
National Provider Identifier
1215919196
Registry record updated Aug 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-107538 Issued in IL
Practice address
333 E Il Route 83 Ste 105
Mundelein, IL 60060-4278
Phone
(847) 970-9922
Fax
(847) 970-9955
NPI assigned
Nov 16, 2005
Last updated
Aug 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2023

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 036-107538 IL Primary

Addresses

Primary practice location

333 E Il Route 83 Ste 105
Mundelein, IL 60060-4278

Mailing address

333 E Il Route 83 Ste 105
Mundelein, IL 60060-4278
Phone (847) 970-9922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040401000611 IL Practitioner - Family Practice 7113919937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cordial Medical Center, S.C.Group PAC ID 6901898873, 3 clinicians

Practice addresses (Care Compare)

333 E Il Route 83
Suite 105
Mundelein, IL 60060-4278
Phone (847) 970-9922

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-107538ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cordial Medical Center, S.C. Family Medicine CurrentSince Nov 1, 2003 Accepting new patients
Hias Diagnostics Inc Past Accepting new patients
Ultrasound Mobile Service, LTD Past Accepting new patients

Locations

1945 W Wilson Ave
Fl 4
Chicago, IL 60640
Phone (773) 736-6220

836 W Wellington Ave
Chicago, IL 60657
Phone (773) 296-7054

801 S Milwaukee Ave
Libertyville, IL 60048
Phone (847) 362-2900

333 E State Route 83
Ste 105
Mundelein, IL 60060
Phone (847) 970-9922

1000 Butterfield Rd
Ste 1005
Vernon Hills, IL 60061
Phone (847) 362-3111

Interoperability endpoints

  • Direct secure messaging: mkhodarkovskiy234690@direct.myadvocateaurora.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Optima Billing ServicesNorthbrook, IL, CCN 141746 Hospice W-2 Managing Employee Jan 2, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691798400000",
    "number": "1215919196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 E IL ROUTE 83 STE 105",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600604278",
            "telephone_number": "847-970-9922",
            "fax_number": "847-970-9955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 E IL ROUTE 83 STE 105",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600604278",
            "telephone_number": "847-970-9922",
            "fax_number": "847-970-9955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHODARKOVSKIY",
        "first_name": "MIKHAIL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2023-08-12",
        "certification_date": "2023-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-107538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mundelein, IL

Sources for this page

Verify at the official NPI Registry.