Individual provider Active NPI

Pouya Jamshidi, MD

  • Neuropathology Physician
  • Chicago, IL
National Provider Identifier
1376905620
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuropathology PhysicianTaxonomy code 207ZN0500X
License
036155214 Issued in IL
Practice address
710 N Fairbanks CT Ste 2-458
Chicago, IL 60611-3013
Phone
(312) 926-3211
Fax
(312) 503-8259
NPI assigned
Mar 25, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X 125.072322 IL
Neuropathology Physician 207ZN0500X 036155214 IL Primary

Addresses

Primary practice location

710 N Fairbanks CT Ste 2-458
Chicago, IL 60611-3013

Mailing address

710 N Fairbanks CT Ste 2-458
Chicago, IL 60611-3013
Phone (312) 926-3211

Other practice location 1

2650 Ridge Ave Rm 1917
Evanston, IL 60201-1700
Phone (847) 570-2019

Other practice location 2

2650 Ridge Ave Ste 1304
Evanston, IL 60201
Phone (847) 570-2019

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
I20230725002099 IL Practitioner - Pathology 5294083770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of California, San Diego School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

251 E Huron
Chicago, IL 60611-2908

251 E Huron St
Chicago, IL 60611-2908

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036155214ILMDNeuropathology Physician
125.072322ILMDAnatomic Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2023 Accepting new patients
Central Dupage Physician Group PastSince Nov 19, 2023 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

710 N Fairbanks Ct
Ste 2458
Chicago, IL 60611
Phone (312) 926-3211

2650 Ridge Ave
Ste 1304
Evanston, IL 60201
Phone (847) 570-1010

2650 Ridge Ave
Rm 1917
Evanston, IL 60201
Phone (847) 570-2019

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 3

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 4

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": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1376905620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N FAIRBANKS CT STE 2-458",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113013",
            "telephone_number": "312-926-3211",
            "fax_number": "312-503-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N FAIRBANKS CT STE 2-458",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113013",
            "telephone_number": "312-926-3211",
            "fax_number": "312-503-8259"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2650 Ridge Ave Rm 1917",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602011700",
            "country_code": "US",
            "telephone_number": "847-570-2019",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2650 Ridge Ave Ste 1304",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "60201",
            "country_code": "US",
            "telephone_number": "847-570-2019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAMSHIDI",
        "first_name": "POUYA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-25",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "IL",
            "license": "125.072322",
            "primary": false
        },
        {
            "code": "207ZN0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Neuropathology",
            "state": "IL",
            "license": "036155214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.