Dejan Micic

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

036132320 Issued in IL

Practice address

5841 S Maryland Ave
Chicago, IL 60637-1443

Phone

(888) 824-0200

NPI assigned

May 18, 2010

Last updated

Oct 24, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Gastroenterology

Education

University of Wisconsin School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Loyola University Medical CenterGroup PAC ID 3779488903, 917 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Loyola University Medical Center Hospital, Maywood, IL, CCN 140276
• Loyola Gottlieb Memorial Hospital Hospital, Melrose Park, IL, CCN 140008

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dmicicmd74148@uchospital.direct-ci.com

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.

• Loyola University Medical Center

  • General Practice Physician
  • Maywood, IL
  • NPI 1336159961
  Medicare reassignment Care Compare group NPD
• Endeavor Health Medical Group

  dba NorthShore University HealthSystem Faculty Practice Associates

  • Allergy & Immunology Physician
  • Evanston, IL
  • NPI 1497701882
  Medicare reassignment NPD
• Loyola Medical Group LLC

  • General Practice Physician
  • Berwyn, IL
  • NPI 1376041954
  Medicare reassignment NPD
• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment NPD
• The University of Chicago Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1033218128
  Medicare reassignment NPD
• Endeavor Health Medical Group

  dba NorthShore Anesthesia Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD
• Loyola University Medical Center

  dba Mulcahy Pharmacy

  • Community/Retail Pharmacy
  • Maywood, IL
  • NPI 1184789299
  NPD
• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• The University of Chicago Medical Center

  dba UCMC Pharmacy Services

  • Community/Retail Pharmacy
  • Calumet City, IL
  • NPI 1255895678
  NPD

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

• Gottlieb Memorial Hospital

  • General Acute Care Hospital
  • Melrose Park, IL
  • NPI 1831170232
  Care Compare affiliation
• Loyola University Medical Center

  dba Foster G. McGaw Hospital

  • General Acute Care Hospital
  • Maywood, IL
  • NPI 1376521575
  Care Compare affiliation
• Loyola University Medical Center

  dba Loyola University Medical Center Cancer Center

  • General Acute Care Hospital
  • Tinley Park, IL
  • NPI 1427752013
  Care Compare affiliation

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

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1356660203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HARVESTER DR",
            "address_2": "SUITE 300",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "888-824-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICIC",
        "first_name": "DEJAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-18",
        "last_updated": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036132320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmicicmd74148@uchospital.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "University of Chicago Physicians Group",
            "address_1": "5841 S Maryland Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606371443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michigan Chicago CVS LLC (CVS Pharmacy)
• Ruth Michon, NP
• Victoria Michonski, CD
• Michrid Supplies LLC
• Cedomir Micic, PHARMD
• Jennifer Mickelson, M.D.
• Lindsay Mickelson, LPC
• Violetta Mickiewicz, PA-C
• Marcia Mickle, NP
• Sophia Mickus

• Gastroenterology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.