Individual provider Active NPI

Mit Patel, MD

  • Family Medicine Physician
  • Berwyn, IL
National Provider Identifier
1245816792
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036170702 Issued in IL
Practice address
3249 Oak Park Ave
Berwyn, IL 60402-3429
Phone
(708) 783-2226
NPI assigned
Mar 23, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 036170702 IL Primary

Addresses

Primary practice location

3249 Oak Park Ave
Berwyn, IL 60402-3429

Mailing address

611 E Douglas Rd Ste 407
Mishawaka, IN 46545-1468

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
I20240806002181 IL Practitioner - Family Practice 4183033467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Loyola Medical Group LLCGroup PAC ID 6305109547, 124 clinicians

Practice addresses (Care Compare)

3249 Oak Park Ave
Berwyn, IL 60402-3429
Phone (708) 783-0700

Hospital & facility affiliations

  • Loyola University Medical Center Hospital, Maywood, IL, CCN 140276
  • Macneal Hospital Hospital, Berwyn, IL, CCN 140054

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036170702ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola Medical Group LLC CurrentSince Aug 1, 2024 Accepting new patients

Locations

3231 Euclid Ave
Ste 407
Berwyn, IL 60402
Phone (708) 783-7430

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

6649 W Archer Ave
Chicago, IL 60638
Phone (773) 586-2100

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

Organizations & group practices 1

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 3

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": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1245816792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD STE 407",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3249 OAK PARK AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023429",
            "telephone_number": "708-783-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "MIT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-23",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036170702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

Verify at the official NPI Registry.