Chinwike T Agbo, MD
Individual provider Active NPI Diagnostic Radiology Physician · Chicago, IL
NPI 1467915652 · NPPES record last updated Oct 1, 2024
Key facts
- NPI
- 1467915652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 036169487 (IL)
- Practice address
- 676 N Saint Clair St Ste 800
Chicago, IL 60611-2978 - Phone
- (312) 695-5978
- NPI assigned
- Apr 13, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 15
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- George Washington University School of Medicine, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northwestern Medical Faculty Foundation
Practice addresses (Care Compare)
676 N Saint Clair St
Suite 800
Chicago, IL 60611-2978
Phone (312) 695-3775
Hospital & facility affiliations
- Northwestern Memorial Hospital
- Northwestern Lake Forest Hospital
- Northwestern Medicine Central Dupage Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240617001583 | IL | Practitioner - Diagnostic Radiology | 3072056290 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036169487 | IL | MD | Body Imaging Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwestern Medical Faculty Foundation | Current |
Accepting new patients | |
| Northwestern Medical Faculty Foundation | Diagnostic Radiology | Current |
Accepting new patients |
Locations
Carol Stream, IL 60122
Phone (630) 933-3300
Dept 5777
Carol Stream, IL 60122
676 N Saint Clair St
Ste 800
Chicago, IL 60611
Phone (312) 695-5753
660 N Westmoreland Rd
#302
Lake Forest, IL 60045
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 036169487 | IL | |
| Diagnostic Radiology Physician | 2085R0202X | 036169487 | IL | Yes |
Addresses
Primary practice location
676 N Saint Clair St Ste 800
Chicago, IL 60611-2978
Mailing address
676 N Saint Clair St Ste 800
Chicago, IL 60611-2978
Phone (845) 544-3576
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All providers in Chicago, IL · Diagnostic Radiology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.