Individual provider Active NPI

Anthony Vaccaro, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1346268844
Registry record updated Jun 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-083332 Issued in IL
Practice address
3245 N Halsted St
Chicago, IL 60657-3419
Phone
(312) 926-3627
NPI assigned
Jul 17, 2006
Last updated
Jun 30, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2010

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 036-083332 IL Primary

Addresses

Primary practice location

3245 N Halsted St
Chicago, IL 60657-3419

Mailing address

3245 N Halsted St
Chicago, IL 60657-3419
Phone (312) 926-3627

Other identifiers 1

IdentifierTypeStateIssuer
036-083332MedicaidIL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20101008000464 IL Practitioner - Internal Medicine 7315139383 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-083332ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2014 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2014 Accepting new patients
Northwestern Memorial Physicians Group Internal Medicine Current Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

111 W Washington St
Ste 1801
Chicago, IL 60602
Phone (312) 726-8800

1333 W Belmont Ave
Ste 200
Chicago, IL 60657
Phone (773) 248-5009

3245 N Halsted St
Chicago, IL 60657
Phone (773) 296-8400

75 Remittance Dr
Dept 1293
Chicago, IL 60675
Phone (312) 926-3642

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277856000000",
    "number": "1346268844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 N HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573419",
            "telephone_number": "312-926-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3245 N HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573419",
            "telephone_number": "312-926-3627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VACCARO",
        "first_name": "ANTHONY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2010-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-083332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-083332",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.