NPIMap

Individual provider Active NPI

Sean Brett Connolly, M.D.

  • Internal Medicine Physician
  • Lake Forest, IL
National Provider Identifier
1346602877
Registry record updated Oct 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036147780 Issued in IL
Practice address
1000 N Westmoreland Rd
Lake Forest, IL 60045-1658
Phone
(847) 234-5600
NPI assigned
Mar 23, 2016
Last updated
Oct 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2022

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 036147780 IL Primary

Addresses

Primary practice location

1000 N Westmoreland Rd
Lake Forest, IL 60045-1658

Mailing address

1000 N Westmoreland Rd
Lake Forest, IL 60045-1658
Phone (847) 234-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190806001926 IL Practitioner - Internal Medicine 6709183304 Reassigns benefits to 1 organization
I20221020000563 CO Practitioner - Internal Medicine 6709183304 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Florida College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1400 E Boulder St
Suite 2508
Colorado Springs, CO 80909-5533
Phone (719) 365-6999

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036147780ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Nov 28, 2022 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Nov 28, 2022 Accepting new patients
Shirley Lee Termolen MD SC Internal Medicine Current Accepting new patients
David a Vermylen MD SC Internal Medicine Current Accepting new patients
Angelo a Costas MD SC Internal Medicine Current Accepting new patients
Ami P Desai MD SC Internal Medicine Current Accepting new patients
Michigan Avenue Internists Internal Medicine CurrentSince Jun 5, 2019 Accepting new patients
Uch-MHS Past Accepting new patients

Locations

1400 E Boulder St
Colorado Springs, CO 80909
Phone (719) 365-5120

1400 E Boulder St
Ste 2508
Colorado Springs, CO 80909
Phone (719) 365-1292

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

200 S Michigan Ave
Ste 1400
Chicago, IL 60604
Phone (312) 922-3815

Organizations & group practices 8

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667001600000",
    "number": "1346602877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N WESTMORELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451658",
            "telephone_number": "847-234-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N WESTMORELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451658",
            "telephone_number": "847-234-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "SEAN",
        "middle_name": "BRETT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-23",
        "last_updated": "2022-10-29",
        "certification_date": "2022-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036147780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, IL

Sources for this page

Verify at the official NPI Registry.