NPIMap

Individual provider Active NPI

Juanbosco Ayala, M.D.

  • Pulmonary Disease Physician
  • Chicago Ridge, IL
National Provider Identifier
1497956981
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
036117517 Issued in IL
Practice address
10604 Southwest Highway
Ste 107
Chicago Ridge, IL 60415-2717
Phone
(708) 422-0636
Fax
(708) 424-2164
NPI assigned
May 30, 2007
Last updated
Jun 20, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036.117517 IL
Pulmonary Disease Physician 207RP1001X 036117517 IL Primary

Addresses

Primary practice location

10604 Southwest Highway
Ste 107
Chicago Ridge, IL 60415-2717

Mailing address

10604 Southwest Highway
Ste 107
Chicago Ridge, IL 60415-2717
Phone (708) 422-0636

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
I20110706000196 IL Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 1254420235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Pulmonary Critical Care and Sleep Consultants LLCGroup PAC ID 5799048526, 31 clinicians

Practice addresses (Care Compare)

12820 S Ridgeland Ave
Suite B
Palos Heights, IL 60463-2389
Phone (708) 371-8006

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.117517ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Pulmonary Critical Care & Sleep Consultants LLC Internal Medicine CurrentSince May 27, 2018 Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients

Locations

2875 W 19th St
Chicago, IL 60623
Phone (773) 484-4300

29777 Network Pl
Chicago, IL 60673

10604 Southwest Hwy
Ste 107
Chicago Ridge, IL 60415
Phone (708) 371-8006

10837 S Cicero Ave
Ste 300
Oak Lawn, IL 60453
Phone (419) 902-2161

12820 S Ridgeland Ave
Ste B
Palos Heights, IL 60463
Phone (708) 371-6009

Organizations & group practices 2

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1497956981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10604 SOUTHWEST HIGHWAY",
            "address_2": "STE 107",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "604152717",
            "telephone_number": "708-422-0636",
            "fax_number": "708-424-2164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10604 SOUTHWEST HIGHWAY",
            "address_2": "STE 107",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "604152717",
            "telephone_number": "708-422-0636",
            "fax_number": "708-424-2164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYALA",
        "first_name": "JUANBOSCO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.117517",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036117517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago Ridge, IL

Sources for this page

Verify at the official NPI Registry.