Irene Thomas-Thevatheril, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

36105417 Issued in IL

Practice address

3080 Ogden Ave Ste 204
Lisle, IL 60532-1694

Phone

(630) 734-0580

Fax

(630) 734-0581

NPI assigned

May 13, 2006

Last updated

Mar 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Family Practice

Education

Baylor College of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uchicago Medicine Adventhealth Hinsdale Hospital, Hinsdale, IL, CCN 140122

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Cornerstone Family Health S.C.

  • Preferred Provider Organization
  • Lisle, IL
  • NPI 1912066788
  Medicare reassignment Authorized official
• Cornerstone Family Healthcare

  • Family Medicine Physician
  • Lisle, IL
  • NPI 1982334843
  NPD Authorized official
• Copley Memorial Hospital, Inc.

  dba Rush Copley Multispecialty Group Practice

  • Endocrinology, Diabetes & Metabolism Physician
  • Aurora, IL
  • NPI 1619466034

  Family Medicine

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Adventist Midwest Health

  • General Acute Care Hospital
  • Hinsdale, IL
  • NPI 1265465439
  Care Compare affiliation
• Adventist Midwest Health

  dba Adventhealth Hinsdale

  • Psychiatric Hospital Unit
  • Hinsdale, IL
  • NPI 1447270780
  Care Compare affiliation

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1336190529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 534",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605320534",
            "telephone_number": "630-734-0580",
            "fax_number": "630-734-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 OGDEN AVE STE 204",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321694",
            "telephone_number": "630-734-0580",
            "fax_number": "630-734-0581"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Community Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "LA Grange",
            "state": "IL",
            "postal_code": "605252659",
            "country_code": "US",
            "telephone_number": "708-245-8900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS-THEVATHERIL",
        "first_name": "IRENE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-13",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36105417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105417",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "irene.thomas.thevatheril.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "1325 Community Memorial Dr",
            "city": "LA Grange",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605252659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Simran Praveen Thadani, PT
• Jigar Thakkar, PHARMD
• The Black Sheep Sanctuary PLLC
• The Center for Insight and Connection PLLC
• The People's OT, PLLC
• Paulette Thomas
• Thrive Mobility and PT LLC
• Diana Tkach, RBT
• Diane Pies Toby, PH.D.
• Breanna Todd, LPC

• Family Medicine Physician in Lisle, IL
• Providers in Lisle, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; 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.

Verify at the official NPI Registry.