NPIMap

Organization Active NPI

Kidney Specialists of Illinois LLC

  • Nephrology Physician
  • Chicago, IL
National Provider Identifier
1275969222
Registry record updated Feb 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
036.125203 Issued in IL
Legal business name
KIDNEY SPECIALISTS OF ILLINOIS LLC
Practice address
5140 N California Ave
Suite 700
Chicago, IL 60625-3645
Phone
(773) 784-2101
Fax
(773) 784-0771
NPI assigned
Sep 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2014

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

Authorized official

Name
Dr. Mustafa Mohammed Ali, M.D.NPI 1184857138
Title
Owner
Phone
(847) 942-6848

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 036.125203 IL Primary

Addresses

Primary practice location

5140 N California Ave
Suite 700
Chicago, IL 60625-3645

Mailing address

5140 N California Ave
Suite 700
Chicago, IL 60625-3645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140227000598 IL Part B Supplier - Clinic/Group Practice 9931339546 Receives reassigned benefits from 6 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

6374 N Lincoln Ave
Ste 201
Chicago, IL 60659
Phone (773) 501-6203

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1275969222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE",
            "address_2": "SUITE 700",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE",
            "address_2": "SUITE 700",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253645",
            "telephone_number": "773-784-2101",
            "fax_number": "773-784-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY SPECIALISTS OF ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-23",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "MUSTAFA",
        "authorized_official_middle_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-942-6848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036.125203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.