NPIMap

Individual provider Active NPI

Aristidis Hatzidimitriadis, MD

  • Internal Medicine Physician
  • Naperville, IL
National Provider Identifier
1508027855
Registry record updated Aug 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125053197 Issued in IL
Practice address
2007 95TH St
Ste 112
Naperville, IL 60564-8561
Phone
(630) 527-7780
Fax
(630) 527-7777
NPI assigned
Jun 19, 2008
Last updated
Aug 4, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125053197 IL Primary

Addresses

Primary practice location

2007 95TH St
Ste 112
Naperville, IL 60564-8561

Mailing address

2007 95TH St
Ste 112
Naperville, IL 60564-8561
Phone (630) 527-7780

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
I20101117000378 IL Practitioner - Internal Medicine 0042405961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Wisconsin, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bonaventure Medical Foundation LLCGroup PAC ID 7517863178, 164 clinicians

Practice addresses (Care Compare)

1339 W Lake St
Addison, IL 60101-1836
Phone (847) 981-5767

1786 Moon Lake Blvd
Hoffman Est, IL 60194-5029
Phone (847) 755-8208

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125053197ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bonaventure Medical Foundation, LLC CurrentSince Dec 1, 2011 Accepting new patients
Edward Health Ventures Internal Medicine Past Accepting new patients
Edward Health Ventures Past Accepting new patients

Locations

1339 W Lake St
Addison, IL 60101
Phone (630) 930-5600

1786 Moon Lake Blvd
Hoffman Estates, IL 60169
Phone (847) 640-5640

190 W Irving Park Rd
Wood Dale, IL 60191
Phone (630) 766-0412

Interoperability endpoints

  • Direct secure messaging: aristidis.hatzidimitriadis.1@380.direct.athenahealth.com

Organizations & group practices 3

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 11

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": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280880000000",
    "number": "1508027855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2007 95TH ST",
            "address_2": "STE 112",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648561",
            "telephone_number": "630-527-7780",
            "fax_number": "630-527-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2007 95TH ST",
            "address_2": "STE 112",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648561",
            "telephone_number": "630-527-7780",
            "fax_number": "630-527-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATZIDIMITRIADIS",
        "first_name": "ARISTIDIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-19",
        "last_updated": "2010-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125053197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.