Individual provider Active NPI

Michael P Grossman, MD

  • Diagnostic Radiology Physician
  • Chicago, IL
National Provider Identifier
1477566990
Registry record updated Oct 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Practice address
2929 S Ellis Ave
Chicago, IL 60616-3395
Phone
(312) 791-2000
NPI assigned
Aug 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X IL Primary

Addresses

Primary practice location

2929 S Ellis Ave
Chicago, IL 60616-3395

Mailing address

2929 S Ellis Ave
Chicago, IL 60616-3395
Phone (312) 791-2000

Other identifiers 1

IdentifierTypeStateIssuer
04915653OtherILBLUE SHIELD ILLINOIS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036041084ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Medical Services Inc Diagnostic Radiology Past Accepting new patients
Emergency Care Physician Services Past Accepting new patients
Future Diagnostics, LTD. Diagnostic Radiology PastSince Feb 1, 2005 Accepting new patients
Accurate Imaging Diagnostic, LTD. Diagnostic Radiology Past Accepting new patients

Organizations & group practices 4

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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1477566990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 S ELLIS AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163395",
            "telephone_number": "312-791-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 S ELLIS AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163395",
            "telephone_number": "312-791-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSSMAN",
        "first_name": "MICHAEL",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD ILLINOIS",
            "identifier": "04915653",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.