Individual provider Active NPI

Kevin J Embach, M.D.

  • Internal Medicine Physician
  • Maywood, IL
National Provider Identifier
1437151974
Registry record updated Mar 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036126913 Issued in IL
Practice address
2160 S 1St Ave
Loyola Univ. Hospital, Room 7604
Maywood, IL 60153-3328
Phone
(708) 216-8757
Fax
(708) 216-1259
NPI assigned
Aug 15, 2005
Last updated
Mar 11, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301051783 MI
Internal Medicine Physician 207R00000X 036126913 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Loyola Univ. Hospital, Room 7604
Maywood, IL 60153-3328

Mailing address

2160 S 1St Ave
Loyola Univ. Hospital, Room 7604
Maywood, IL 60153-3328
Phone (708) 216-8757

Other identifiers 1

IdentifierTypeStateIssuer
2801074MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20190213000200 NE Practitioner - Internal Medicine 6002991825 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Virginia School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, 951 clinicians

Practice addresses (Care Compare)

7710 Mercy Rd
Suite 3000
Omaha, NE 68124-2350
Phone (402) 343-8650

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036126913ILMDInternal Medicine Physician
4301051783MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic CurrentSince Feb 1, 2019 Accepting new patients
Alegent Creighton Clinic Internal Medicine Past Accepting new patients

Locations

2771 Solution Ctr
Chicago, IL 60677

16909 Lakeside Hills Ct
Ste 300
Omaha, NE 68130
Phone (402) 758-5400

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

7710 Mercy Rd
Ste 3000
Omaha, NE 68124
Phone (402) 717-9600

Organizations & group practices 2

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 2

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": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299801600000",
    "number": "1437151974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "LOYOLA UNIV. HOSPITAL, ROOM 7604",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-8757",
            "fax_number": "708-216-1259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "LOYOLA UNIV. HOSPITAL, ROOM 7604",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-8757",
            "fax_number": "708-216-1259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMBACH",
        "first_name": "KEVIN",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2011-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301051783",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036126913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2801074",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.