Individual provider Active NPI

Ariel Gliksberg

  • Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1275911034
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036145876 Issued in IL
Practice address
1740 W Taylor St
Chicago, IL 60612-7232
Phone
(866) 600-2273
NPI assigned
May 13, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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
Pediatrics Physician 208000000X 036145876 IL Primary

Addresses

Primary practice location

1740 W Taylor St
Chicago, IL 60612-7232

Mailing address

720 N Larrabee St Apt 701
Chicago, IL 60654-5052

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
I20190911000851 IL Practitioner - Pediatric Medicine 2365742517 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Pediatrics CurrentSince Jul 30, 2019 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Ann & Robert H. Lurie Children'S Hospital of Chicago Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jul 30, 2019 Accepting new patients
The Board of Trustees of the University of Illinois Pediatrics Past Accepting new patients
Associated Pediatrics LTD Pediatrics Past Accepting new patients
Associated Pediatric Partners,S.C. Pediatrics PastSince Oct 30, 2022 Accepting new patients

Locations

840 S Wood St
#856
Chicago, IL 60612
Phone (312) 413-1429

1740 W Taylor St
Chicago, IL 60612
Phone (312) 355-4000

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1769/brand/1/csg/1/fhir/r4
  • Direct secure messaging: ariel.gliksberg.1@1769.direct.athenahealth.com
  • Direct secure messaging: agliksberg265795@direct.luriechildrens.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1275911034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 N LARRABEE ST APT 701",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606545052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127232",
            "telephone_number": "866-600-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLIKSBERG",
        "first_name": "ARIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-13",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036145876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.