Justin Ryan Gavino Andrada, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036177051 Issued in IL

Practice address

1007 Church St Ste 100
Evanston, IL 60201-5910

Phone

(847) 475-4555

Fax

(847) 866-6035

NPI assigned

May 30, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Family Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Residential Home Health Home health agency, Northbrook, IL, CCN 147001
• Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: justin.ryan.andrada.1@3547.direct.athenahealth.com

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.

• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Select Rehabilitation, LLC

  • Rehabilitation Clinic/Center
  • Glenview, IL
  • NPI 1346368248
  Care Compare group
• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Endeavor Health Clinical Operations

  • General Acute Care Hospital
  • Evanston, IL
  • NPI 1184670549
  Care Compare affiliation
• Residential Home Health Illinois, LLC

  • Home Health Agency
  • Northbrook, IL
  • NPI 1114673787
  Care Compare affiliation

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

{
    "created_epoch": "1622332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771372800000",
    "number": "1447826573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 CHURCH ST STE 100",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602015910",
            "telephone_number": "847-475-4555",
            "fax_number": "847-475-0154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 CHURCH ST STE 100",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602015910",
            "telephone_number": "847-475-4555",
            "fax_number": "847-866-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRADA",
        "first_name": "JUSTIN RYAN",
        "middle_name": "GAVINO",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-30",
        "last_updated": "2026-02-18",
        "certification_date": "2026-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036177051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Paul Anderson, D.O.
• Kenton Anderson, ND
• Lauren Anderson, MD
• Patricia Simmons Anderson, P.T.
• Zachary M Anderson, PH.D.
• Andrea Lee OBGYN PLLC
• Emily Kirsten Andrew, MD
• Preetha Andrews
• Jessica Andrick, LPC
• Marlene Angelico, CNP

• Family Medicine Physician in Evanston, IL
• Providers in Evanston, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.