Cornelius Avery Mitchell, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.115063 Issued in IL

Practice address

31 W 155TH St
Harvey, IL 60426-3556

Phone

(708) 596-5177

Fax

(708) 339-3583

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Family Practice

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healogics Specialty Physicians of Illinois, LLCGroup PAC ID 4486877511, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Advocare Home Services Home health agency, Elk Grove Village, IL, CCN 148401
• Loyola Gottlieb Memorial Hospital Hospital, Melrose Park, IL, CCN 140008
• Holy Cross Hospital Hospital, Chicago, IL, CCN 140133
• Loyola University Medical Center Hospital, Maywood, IL, CCN 140276
• Mt Sinai Hospital Medical Center Hospital, Chicago, IL, CCN 140018

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Healogics Specialty Physicians of Illinois, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Alton, IL
  • NPI 1215355110

  Family Medicine

  Medicare reassignment Care Compare group NPD

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

• Crex Resources LLC

  • Home Health Agency
  • Elk Grove Village, IL
  • NPI 1194442533
  Care Compare affiliation
• Gottlieb Memorial Hospital

  • General Acute Care Hospital
  • Melrose Park, IL
  • NPI 1831170232
  Care Compare affiliation
• Holy Cross Hospital

  • Psychiatric Hospital Unit
  • Chicago, IL
  • NPI 1427547538
  Care Compare affiliation
• Holy Cross Hospital

  • Substance Abuse Rehabilitation Facility
  • Chicago, IL
  • NPI 1770335770

  Hospital

  Care Compare affiliation
• Holy Cross Hospital

  • Substance Abuse Rehabilitation Facility
  • Chicago, IL
  • NPI 1821840828

  Hospital

  Care Compare affiliation
• Holy Cross Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1962425611
  Care Compare affiliation
• Loyola University Medical Center

  • General Acute Care Hospital
  • Maywood, IL
  • NPI 1376521575
  Care Compare affiliation
• Loyola University Medical Center

  • General Acute Care Hospital
  • Tinley Park, IL
  • NPI 1427752013
  Care Compare affiliation
• Mount Sinai Hospital Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1871581314
  Care Compare affiliation

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534377600000",
    "number": "1225065345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9119 S EXCHANGE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174225",
            "telephone_number": "773-768-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177",
            "fax_number": "708-339-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "CORNELIUS",
        "middle_name": "AVERY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2018-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.115063",
            "primary": true
        },
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "IL",
            "license": "036115063",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036115063",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ardeshir R Medhat, MD
• Carol Ann Meyers, M.D.
• Michael T Jones DMD LTD
• Midwest Emergency Associates LTD
• Mik Priortee Health LLC
• Juanita Mitchell
• Monroe Medical Associates, SC
• Jerold I. Morantz, D.C.
• Katrina Nicole Morgan
• Madeline T. Moriarty, MD

• Family Medicine Physician in Harvey, IL
• Providers in Harvey, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.