Active NPI
Mark Amdur, MD
- Psychiatry Physician
- Berwyn, IL
National Provider Identifier
1346277274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036044305
- Practice address
- 6201 Roosevelt Rd
Berwyn, IL 60402-1108 - Phone
- (708) 386-0845
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 036044305 | IL | Primary |
Addresses
Primary practice location
6201 Roosevelt Rd
Berwyn, IL 60402-1108
Mailing address
4250 N Marine Dr
Suite 236
Chicago, IL 60613-1744
Phone (773) 404-0160
Other practice location 1
4250 N Marine Dr
Suite 236
Chicago, IL 60613-1744
Phone (773) 404-0160
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036044305 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Thresholds | Past | Accepting new patients |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Westmont, IL
- NPI 1083590996
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577059200000",
"number": "1346277274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4250 N MARINE DR",
"address_2": "SUITE 236",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606131744",
"telephone_number": "773-404-0160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6201 ROOSEVELT RD",
"city": "BERWYN",
"state": "IL",
"postal_code": "604021108",
"telephone_number": "708-386-0845"
}
],
"practiceLocations": [
{
"address_1": "4250 N Marine Dr",
"address_2": "SUITE 236",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606131744",
"country_code": "US",
"telephone_number": "773-404-0160",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "AMDUR",
"first_name": "MARK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2019-12-23",
"certification_date": "2019-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036044305",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036044305",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.