Individual provider Active NPI

Alexis Cavanaugh, M.D.

  • Pediatric Gastroenterology Physician
  • Evanston, IL
National Provider Identifier
1437457876
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
036138011 Issued in IL
Practice address
1000 Central St Ste 800
Evanston, IL 60201-1780
Phone
(847) 570-1795
NPI assigned
Mar 9, 2011
Last updated
Jul 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 036138011 IL Primary

Addresses

Primary practice location

1000 Central St Ste 800
Evanston, IL 60201-1780

Mailing address

4440 W 95TH St
Oak Lawn, IL 60453-2600

Other practice location 1

4440 W 95th St
Oak Lawn, IL 60453-2600
Phone (708) 684-5338

Other names 1

  • Alexis Altagracia Rodriguez Former name

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
I20230412002288 IL Practitioner - GastroenterologyPractitioner - Pediatric Medicine 5193190759 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036138011ILMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center CurrentSince Nov 1, 2023 Accepting new patients
Endeavor Health Medical Group CurrentSince Mar 3, 2023 Accepting new patients
Loyola University Medical Center CurrentSince Nov 1, 2023 Accepting new patients
Endeavor Health Medical Group Current Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

1000 Central St
Evanston, IL 60201
Phone (847) 570-1000

1000 Central St
Ste 800
Evanston, IL 60201
Phone (847) 570-2503

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

500 W Court St
Kankakee, IL 60901
Phone (800) 585-4119

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

2 Westbrook Corporate Ctr
Ste 600
Westchester, IL 60154
Phone (708) 216-5092

3232 Lake Ave
Ste 330
Wilmette, IL 60091
Phone (224) 226-9420

Interoperability endpoints

  • Direct secure messaging: arodriguez153324@uihealth.direct-ci.com
  • Direct secure messaging: arodriguez49345@direct.edward.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1299628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1437457876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CENTRAL ST STE 800",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011780",
            "telephone_number": "847-570-1795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4440 W 95th St",
            "address_purpose": "LOCATION",
            "city": "Oak Lawn",
            "state": "IL",
            "postal_code": "604532600",
            "country_code": "US",
            "telephone_number": "708-684-5338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAVANAUGH",
        "first_name": "ALEXIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-09",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "IL",
            "license": "036138011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXIS",
            "last_name": "RODRIGUEZ",
            "middle_name": "ALTAGRACIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.