Individual provider Active NPI

Urooj Yazdani, MD, M.ED.

  • Child & Adolescent Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1447749569
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
Y78954689087 Issued in IL
Practice address
5841 S Maryland Ave
Chicago, IL 60637-1443
Phone
(773) 702-3858
NPI assigned
May 3, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X Y78954689087 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave
Chicago, IL 60637-1443

Mailing address

623 Brummel St Apt 2
Evanston, IL 60202-3907

Other practice location 1

530 S Jackson St
Louisville, KY 40202-1675
Phone (202) 621-4354

Other practice location 2

1622 Willow Rd Ste 200
Northfield, IL 60093-3450
Phone (847) 853-0234

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
I20240813001345 IL Practitioner - Psychiatry 7517369739 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Y78954689087ILMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Services Corporation of Southern Illinois Inc. CurrentSince Jul 30, 2024 Accepting new patients
Afg Guidance Center LTD Child & Adolescent Psychiatry Past Accepting new patients

Locations

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1447749569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 BRUMMEL ST APT 2",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602023907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "773-702-3858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "530 S Jackson St",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402021675",
            "country_code": "US",
            "telephone_number": "202-621-4354",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1622 Willow Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Northfield",
            "state": "IL",
            "postal_code": "600933450",
            "country_code": "US",
            "telephone_number": "847-853-0234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YAZDANI",
        "first_name": "UROOJ",
        "credential": "MD, M.ED.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-03",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "Y78954689087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.