NPIMap

Individual provider Active NPI

Vairavan Viswanathan, M.D.

  • Internal Medicine Physician
  • Joliet, IL
National Provider Identifier
1326083890
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
36-087483 Issued in IL
Practice address
2100 Glenwood Ave
Joliet, IL 60435-5487
Phone
(815) 725-2121
Fax
(815) 741-6303
NPI assigned
Jun 18, 2006
Last updated
Aug 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36-087483 IL Primary

Addresses

Primary practice location

2100 Glenwood Ave
Joliet, IL 60435-5487

Mailing address

PO Box 713260
Chicago, IL 60677-1260
Phone (630) 469-9200

Other identifiers 1

IdentifierTypeStateIssuer
36087483MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vviswanathan50774@dulyhealthandcare.direct-ci.com

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
I20081218000451 IL Practitioner - Internal Medicine 3577653203 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dupage Medical Group LTDGroup PAC ID 5496667941, 1,326 clinicians

Practice addresses (Care Compare)

2100 Glenwood Ave
Joliet, IL 60435-5487
Phone (815) 725-2121

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36-087483ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Meridian Medical Associates Current Accepting new patients
Dupage Medical Group LTD CurrentSince Oct 1, 2015 Accepting new patients
Dupage Medical Group LTD CurrentSince Oct 1, 2015 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210

1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000

2100 Glenwood Ave
Joliet, IL 60435
Phone (815) 999-3201

301 Madison St
Ste 207
Joliet, IL 60435

Interoperability endpoints

  • Direct secure messaging: vviswanathan50774@dulyhealthandcare.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1326083890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771260",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 GLENWOOD AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604355487",
            "telephone_number": "815-725-2121",
            "fax_number": "815-741-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VISWANATHAN",
        "first_name": "VAIRAVAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "36-087483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36087483",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vviswanathan50774@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "address_1": "2100 Glenwood Ave",
            "city": "Joliet",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604355487",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.