Active NPI
Michael G Nellamattathil, DO
- Diagnostic Radiology Physician
- Evanston, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 036155190
- Practice address
- 2650 Ridge Ave.
Dept. of Radiology
Evanston, IL 60201 - Phone
- (847) 570-2477
- Fax
- (847) 570-2942
- NPI assigned
- Mar 26, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 036155190 | IL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Diagnostic Radiology Physician | 2085R0202X | 036155190 | IL | Primary |
| Diagnostic Radiology Physician | 2085R0202X | OS23944 | FL |
Addresses
Primary practice location
2650 Ridge Ave.
Dept. of Radiology
Evanston, IL 60201
Mailing address
2650 Ridge Ave
Evanston, IL 60201-1700
Phone (847) 570-2477
Other practice location 1
836 W Wellington Ave
Chicago, IL 60657-5147
Phone (773) 296-5424
Other practice location 2
676 N Saint Clair St Ste 800
Chicago, IL 60611-2978
Phone (312) 695-5753
Other practice location 3
3402 W Dr Martin Luther King Jr Blvd
Tampa, FL 33607-6214
Phone (813) 875-3950
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 131707900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Philadelphia College of Osteopathic Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2650 Ridge Ave
Suite 2218a
Evanston, IL 60201-1700
Phone (847) 503-4222
Hospital & facility affiliations
- Northshore University Healthsystem - Evanston Hospital
- Swedish Hospital
- Northwestern Medicine Central Dupage Hospital
- Northwestern Lake Forest Hospital
- Advocate Lutheran General Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.9 of 100
- Quality
- 75.91
- Promoting interoperability
- 99
- Improvement activities
- 40
- Cost
- 74.6
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Niles Open MRI Inc | Current | Accepting new patients | |
| Endeavor Health Medical Group | Current | Accepting new patients | |
| Endeavor Health Medical Group | Current | Accepting new patients |
Locations
9532 Eagle Way
Chicago, IL 60678
2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222
2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206
2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172
660 N Westmoreland Rd
#302
Lake Forest, IL 60045
Organizations & group practices 4
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.
-
- Emergency Medicine Physician
- Evanston, IL
- NPI 1497701882
-
- Medical Oncology Physician
- Cape Coral, FL
- NPI 1760590962
-
- Anesthesiology Physician
- Evanston, IL
- NPI 1265695944
-
- Magnetic Resonance Imaging (MRI) Clinic/Center
- Niles, IL
- NPI 1720211360
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Park Ridge, IL
- NPI 1164539730
-
- General Acute Care Hospital
- Winfield, IL
- NPI 1003864810
-
- Psychiatric Hospital Unit
- Winfield, IL
- NPI 1740230895
-
- General Acute Care Hospital
- Evanston, IL
- NPI 1184670549
-
- General Acute Care Hospital
- Lake Forest, IL
- NPI 1124025176
-
- General Acute Care Hospital
- Chicago, IL
- NPI 1831151257
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782345600000",
"number": "1316309537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 RIDGE AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602011700",
"telephone_number": "847-570-2477",
"fax_number": "847-570-2942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 RIDGE AVE.",
"address_2": "DEPT. OF RADIOLOGY",
"city": "EVANSTON",
"state": "IL",
"postal_code": "60201",
"telephone_number": "847-570-2477",
"fax_number": "847-570-2942"
}
],
"practiceLocations": [
{
"address_1": "836 W Wellington Ave",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606575147",
"country_code": "US",
"telephone_number": "773-296-5424",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "676 N Saint Clair St Ste 800",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606112978",
"country_code": "US",
"telephone_number": "312-695-5753",
"fax_number": "312-695-5645",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3402 W Dr Martin Luther King Jr Blvd",
"address_purpose": "LOCATION",
"city": "Tampa",
"state": "FL",
"postal_code": "336076214",
"country_code": "US",
"telephone_number": "813-875-3950",
"fax_number": "813-872-2741",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NELLAMATTATHIL",
"first_name": "MICHAEL",
"middle_name": "G",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-26",
"last_updated": "2026-06-25",
"certification_date": "2026-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "IL",
"license": "036155190",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IL",
"license": "036155190",
"primary": true
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "FL",
"license": "OS23944",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "131707900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.