Individual provider Active NPI

Phillip Ahn, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1376527879
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036089338 Issued in IL
Practice address
4321 S Pulaski Rd
Chicago, IL 60632-4008
Phone
(773) 585-2410
Fax
(773) 284-0913
NPI assigned
Nov 30, 2005
Last updated
Mar 29, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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 036089338 IL Primary

Addresses

Primary practice location

4321 S Pulaski Rd
Chicago, IL 60632-4008

Mailing address

2525 S Michigan Ave
B-390
Chicago, IL 60616-2333
Phone (312) 567-6691

Other identifiers 3

IdentifierTypeStateIssuer
01621679OtherILBCBS OF IL
205737OtherILMEDICARE PTAN
036089338 / 02MedicaidIL

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
I20100714000278 IL Practitioner - Family Practice 5193857985 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians

Practice addresses (Care Compare)

5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (888) 824-0200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Chicago Medical Center CurrentSince Jun 1, 2021 Accepting new patients
The University of Chicago Medical Center CurrentSince Jun 1, 2021 Accepting new patients
University of Chicago CurrentSince Jun 1, 2021 Accepting new patients
Edna Richard M D Past Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

2525 S Michigan Ave
Chicago, IL 60616
Phone (312) 355-1153

2525 S Michigan Ave
#B390
Chicago, IL 60616
Phone (312) 567-6691

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Interoperability endpoints

  • Direct secure messaging: pahn211712@uchospital.direct-ci.com

Organizations & group practices 4

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 1

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": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459209600000",
    "number": "1376527879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 S MICHIGAN AVE",
            "address_2": "B-390",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162333",
            "telephone_number": "312-567-6691",
            "fax_number": "312-328-7895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4321 S PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606324008",
            "telephone_number": "773-585-2410",
            "fax_number": "773-284-0913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHN",
        "first_name": "PHILLIP",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2016-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036089338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "01621679",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "205737",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036089338 / 02",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.