NPIMap

Individual provider Active NPI

Prakash Selvaraj, M.D.

  • Ophthalmology Physician
  • Bolingbrook, IL
National Provider Identifier
1467454124
Registry record updated Oct 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
036-095872 Issued in IL
Practice address
396 Remington Blvd
Suite 340
Bolingbrook, IL 60440-1732
Phone
(630) 759-9800
NPI assigned
Aug 12, 2005
Last updated
Oct 4, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 036-095872 IL Primary

Addresses

Primary practice location

396 Remington Blvd
Suite 340
Bolingbrook, IL 60440-1732

Mailing address

3537 Paysphere Cir
Chicago, IL 60674-0035
Phone (708) 786-2900

Other identifiers 1

IdentifierTypeStateIssuer
036-095872-1MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051103001174 IL Practitioner - Ophthalmology 6103844527 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Ohio State University College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mount Sinai Community FoundationGroup PAC ID 5991600405, 247 clinicians

Practice addresses (Care Compare)

1401 S California Ave
Chicago, IL 60608-1858
Phone (773) 522-6656

2701 W 68TH St
Chicago, IL 60629-1813
Phone (773) 884-9000

396 Remington Blvd
Suite 340
Bolingbrook, IL 60440-4310
Phone (630) 759-9800

California Ave at 15TH St
Chicago, IL 60608-1858
Phone (773) 542-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
19.38 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
64.6

Merit-based Incentive Payment System (MIPS)

Final score
94.03 of 100Reported as group
Quality
71.53
Promoting interoperability
100
Improvement activities
40
Cost
76.89

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery110

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-095872ILMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Sinai Community Foundation Current Accepting new patients
West Suburban Eye Center, S.C. Ophthalmology CurrentSince Apr 1, 2003 Accepting new patients
Mount Sinai Community Foundation CurrentSince May 1, 2013 Accepting new patients
Mount Sinai Community Foundation Ophthalmology CurrentSince May 1, 2013 Accepting new patients
Bertram Kraft, MD, SC Ophthalmology PastSince Jan 28, 2011 Accepting new patients
Midwest Eye Center Ophthalmology Past Accepting new patients

Locations

396 Remington Blvd
Ste 340
Bolingbrook, IL 60440
Phone (630) 759-9800

1501 S California Ave
#7140
Chicago, IL 60608
Phone (773) 257-4758

26460 Network Pl
Chicago, IL 60673
Phone (708) 786-2900

3537 Paysphere Cir
Chicago, IL 60674

Organizations & group practices 7

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": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317686400000",
    "number": "1467454124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3537 PAYSPHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606740035",
            "telephone_number": "708-786-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 REMINGTON BLVD",
            "address_2": "SUITE 340",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401732",
            "telephone_number": "630-759-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELVARAJ",
        "first_name": "PRAKASH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2011-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036-095872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-095872-1",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

Verify at the official NPI Registry.