Hythem P Shadid, M.D.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

036082388 Issued in IL

Practice address

2900 Foxfield Rd
Suite 102
St Charles, IL 60174-5799

Phone

(630) 377-1188

Fax

(630) 377-7360

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

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

Orthopedic Surgery

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Genesis Orthopedics and Sports Medicine LLCGroup PAC ID 7618955808, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Presence Mercy Medical Center Hospital, Aurora, IL, CCN 140174
• Humboldt Park Health Hospital, Chicago, IL, CCN 140206
• Uchicago Medicine Adventhealth Glenoaks Hospital, Glendale Heights, IL, CCN 140292

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2069/brand/1/csg/29/fhir/r4

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.

• Genesis Orthopedics & Sports Medicine LLC

  • Orthopaedic Surgery Physician
  • St Charles, IL
  • NPI 1346389061

  Sports Medicine

  Medicare reassignment Care Compare group NPD Authorized official
• Waukegan Clinic Corp

  • Family Medicine Physician
  • Waukegan, IL
  • NPI 1306937289
  Medicare reassignment NPD
• Genesis Orthopedics & Sports Medicine LLC

  • Durable Medical Equipment & Medical Supplies
  • Oak Brook, IL
  • NPI 1467954016
  NPD Authorized official
• Genesis Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • St Charles, IL
  • NPI 1699557447
  NPD
• Oncology Hematology Associates of Northern Illinois, LTD

  • Hematology & Oncology Physician
  • Gurnee, IL
  • NPI 1093142135
  NPD

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

• Adventist Glenoaks Hospital

  • Psychiatric Hospital Unit
  • Glendale Heights, IL
  • NPI 1477572949
  Care Compare affiliation
• Adventist Glenoaks Hospital

  • General Acute Care Hospital
  • Glendale Heights, IL
  • NPI 1760415939
  Care Compare affiliation
• Humboldt Park Health

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1972594877
  Care Compare affiliation
• Mercy Medical Center - Aurora LLC

  • General Acute Care Hospital
  • Aurora, IL
  • NPI 1598503922
  Care Compare affiliation

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334880000000",
    "number": "1477567394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD",
            "address_2": "SUITE 102",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-377-1188",
            "fax_number": "630-377-7360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD",
            "address_2": "SUITE 102",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-377-1188",
            "fax_number": "630-377-7360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADID",
        "first_name": "HYTHEM",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2012-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IL",
            "license": "036082388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1477567394",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HFS PAYEE ID",
            "identifier": "3643336556019001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "DO4326",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "04525539",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD (PTAN)",
            "identifier": "200038958",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036082388",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#",
            "identifier": "364333655",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Serene Chiropractic Inc.
• Serene Infusion and Wellness Lounge LLC
• Maureen Christina Sevandal, D.D.S, M.S.
• Nashira Sey, M.D.
• Jill K. Shackelford, CCC-SLP
• Mansi Rocky Shah
• Parul Shah
• Behnoosh Shahrokh, APRN, CNP
• Diane Marie Shallcross, APRN, FPA, PMHNP-BC
• Madison Sharkey, RBT

• Sports Medicine (Orthopaedic Surgery) Physician in St Charles, IL
• Providers in St Charles, IL by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2012; 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.