Active NPI
On Site Dermatology of Illinois PLLC
- Dermatology Physician
- Chicago, IL
National Provider Identifier
1437859592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- ON SITE DERMATOLOGY OF ILLINOIS PLLC
- Practice address
- 2960 N Lake Shore Dr
Chicago, IL 60657-5600 - Phone
- (877) 345-5300
- Fax
- (561) 989-3665
- NPI assigned
- Mar 7, 2023
- Last updated
- Apr 7, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Animesh Sinha, MD
- Title
- Manager
- Phone
- (561) 314-2000
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
2960 N Lake Shore Dr
Chicago, IL 60657-5600
Mailing address
4700 Exchange CT Ste 110
Boca Raton, FL 33431-4450
Phone (561) 314-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
515 W Rand Rd
Arlington Heights, IL 60004
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Physician Assistant
- Chicago, IL
- NPI 1447073614
-
- Occupational Therapy Assistant
- Palatine, IL
- NPI 1487413118
-
- Optometrist
- Chicago, IL
- NPI 1558313189
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678147200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1680825600000",
"number": "1437859592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 EXCHANGE CT STE 110",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334314450",
"telephone_number": "561-314-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2960 N LAKE SHORE DR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606575600",
"telephone_number": "877-345-5300",
"fax_number": "561-989-3665"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ON SITE DERMATOLOGY OF ILLINOIS PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-03-07",
"last_updated": "2023-04-07",
"certification_date": "2023-04-07",
"status": "A",
"authorized_official_last_name": "SINHA",
"authorized_official_first_name": "ANIMESH",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "561-314-2000",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.