NPIMap

Individual provider Active NPI

Manohar L Jethani, MD

  • Family Medicine Physician
  • Berwyn, IL
National Provider Identifier
1366529505
Registry record updated Nov 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036046173 Issued in IL
Practice address
3635 Harlem Ave
Berwyn, IL 60402-3212
Phone
(708) 447-9402
Fax
(708) 447-3246
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036046173 IL Primary

Addresses

Primary practice location

3635 Harlem Ave
Berwyn, IL 60402-3212

Mailing address

3635 Harlem Ave
Berwyn, IL 60402-3212
Phone (708) 447-9402

Other identifiers 3

IdentifierTypeStateIssuer
036046173OtherILLICENSE #
14D0857955OtherILCLIA #
01616688OtherILBC/BS PROVIDER #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080930000317 IL Practitioner - Family PracticePractitioner - Internal MedicinePractitioner - Emergency Medicine 6406923648 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 1967
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthstop SCGroup PAC ID 6305176884, 2 clinicians

Practice addresses (Care Compare)

3635 S Harlem Ave
Berwyn, IL 60402-3212
Phone (708) 447-9402

Hospital & facility affiliations

  • Loyola Medicine Home Care Home health agency, Oak Brook, IL, CCN 147257
  • Uchicago Medicine Adventhealth Home Care Home health agency, La Grange, IL, CCN 147207
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Macneal Hospital Hospital, Berwyn, IL, CCN 140054
  • Loyola University Medical Center Hospital, Maywood, IL, CCN 140276
  • Uchicago Medicine Adventhealth Hinsdale Hospital, Hinsdale, IL, CCN 140122

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036046173ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthstop SC Family Medicine CurrentSince Sep 1, 2019 Accepting new patients

Locations

3635 S Harlem Ave
Berwyn, IL 60402
Phone (708) 245-9000

Interoperability endpoints

  • Direct secure messaging: manohar.jethani.1@20505.direct.athenahealth.com

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414972800000",
    "number": "1366529505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3635 HARLEM AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023212",
            "telephone_number": "708-447-9402",
            "fax_number": "708-447-3246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 HARLEM AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023212",
            "telephone_number": "708-447-9402",
            "fax_number": "708-447-3246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETHANI",
        "first_name": "MANOHAR",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2014-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036046173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "036046173",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "14D0857955",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER #",
            "identifier": "01616688",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

Verify at the official NPI Registry.