NPIMap

Individual provider Active NPI

Nejat Destani, M.D.

  • Family Medicine Physician
  • Berwyn, IL
National Provider Identifier
1295738771
Registry record updated Mar 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036086642 Issued in IL
Practice address
6840 Windsor Ave
Berwyn, IL 60402-3441
Phone
(708) 484-0042
Fax
(708) 749-5489
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036086642 IL Primary

Addresses

Primary practice location

6840 Windsor Ave
Berwyn, IL 60402-3441

Mailing address

6840 Windsor Ave
Berwyn, IL 60402-3441
Phone (708) 484-0042

Other identifiers 1

IdentifierTypeStateIssuer
036086642MedicaidIL

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
I20100709000762 IL Practitioner - Family Practice 3678535473 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Care Associates LTDGroup PAC ID 7416917059, 9 clinicians

Practice addresses (Care Compare)

6840 W Windsor Ave
Berwyn, IL 60402-3441
Phone (708) 484-0042

6840 Windsor Ave
Berwyn, IL 60402-3441

Hospital & facility affiliations

  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Macneal Hospital Hospital, Berwyn, IL, CCN 140054
  • Loyola University Medical Center Hospital, Maywood, IL, CCN 140276
  • Uchicago Medicine Adventhealth Hinsdale Hospital, Hinsdale, IL, CCN 140122
  • Uchicago Medicine Adventhealth la Grange Hospital, La Grange, IL, CCN 140065

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036086642ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Associates LTD Family Medicine CurrentSince Jan 1, 1987 Accepting new patients

Locations

6840 W Windsor Ave
Berwyn, IL 60402
Phone (708) 484-0042

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 9

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": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299628800000",
    "number": "1295738771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6840 WINDSOR AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023441",
            "telephone_number": "708-484-0042",
            "fax_number": "708-749-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6840 WINDSOR AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023441",
            "telephone_number": "708-484-0042",
            "fax_number": "708-749-5489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTANI",
        "first_name": "NEJAT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2011-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036086642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086642",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

Verify at the official NPI Registry.