NPIMap

Individual provider Active NPI

Sergei Shevlyagin, MD

  • Internal Medicine Physician
  • Mundelein, IL
National Provider Identifier
1235123589
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-100102 Issued in IL
Practice address
550 N Lake St
Mundelein, IL 60060-1827
Phone
(847) 548-9777
Fax
(847) 548-9797
NPI assigned
Sep 1, 2005
Last updated
Jun 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-100102 IL Primary

Addresses

Primary practice location

550 N Lake St
Mundelein, IL 60060-1827

Mailing address

550 N Lake St
Mundelein, IL 60060-1827
Phone (847) 548-9777

Other identifiers 1

IdentifierTypeStateIssuer
03697846MedicaidIL

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
I20031112000515 IL Practitioner - Internal MedicinePractitioner - Diagnostic Radiology 3870406010 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Diagnostic Radiology
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

550 N Lake St
Mundelein, IL 60060-1827
Phone (847) 548-9777

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.91 of 100Reported as individual
Quality
84.6
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-100102ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Atkinson Clinic SC Internal Medicine CurrentSince Aug 15, 2001 Accepting new patients
Rand Imaging Center Past Accepting new patients
City of Hope Medical Group of Illinois PLLC Past Accepting new patients

Locations

100 N Atkinson Rd
Ste 207
Grayslake, IL 60030
Phone (847) 548-9777

550 N Lake St
Mundelein, IL 60060
Phone (847) 548-9777

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1235123589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 N LAKE ST",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601827",
            "telephone_number": "847-548-9777",
            "fax_number": "847-548-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 N LAKE ST",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601827",
            "telephone_number": "847-548-9777",
            "fax_number": "847-548-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEVLYAGIN",
        "first_name": "SERGEI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-100102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03697846",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mundelein, IL

Sources for this page

Verify at the official NPI Registry.