NPIMap

Individual provider Active NPI

Tina C Bansal, M.D

  • Endocrinology, Diabetes & Metabolism Physician
  • Schaumburg, IL
National Provider Identifier
1508955956
Registry record updated May 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
036112667 Issued in IL
Practice address
800 E Woodfield Rd Ste 113
Schaumburg, IL 60173-4786
Phone
(847) 686-6866
Fax
(847) 706-9891
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X 036112667 IL Primary

Addresses

Primary practice location

800 E Woodfield Rd Ste 113
Schaumburg, IL 60173-4786

Mailing address

800 E Woodfield Rd Ste 113
Schaumburg, IL 60173-4786
Phone (847) 686-6866

Other identifiers 2

IdentifierTypeStateIssuer
202189914OtherILTAX IDENTIFICATION
036112667MedicaidIL

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
I20050309000322 IL Practitioner - Endocrinology 1557315314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advanced Endocrionology LLCGroup PAC ID 6103870951, 5 clinicians

Practice addresses (Care Compare)

800 E Woodfield Rd
Suite 113
Schaumburg, IL 60173-4786
Phone (847) 686-6866

Hospital & facility affiliations

  • St Alexius Medical Center Hospital, Hoffman Estates, IL, CCN 140290
  • Alexian Brothers Medical Center 1 Hospital, Elk Grove Village, IL, CCN 140258
  • Northwest Community Hospital 1 Hospital, Arlington Heights, IL, CCN 140252
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Loyola University Medical Center Hospital, Maywood, IL, CCN 140276

Merit-based Incentive Payment System (MIPS)

Final score
89.33 of 100Reported as individual
Quality
80.9
Promoting interoperability
100
Improvement activities
40
Cost
74.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036112667ILMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Endocrionology LLC Single Specialty CurrentSince Jan 20, 2005 Accepting new patients

Locations

800 E Woodfield Rd
Ste 113
Schaumburg, IL 60173
Phone (847) 686-6866

Interoperability endpoints

  • Direct secure messaging: tina.bansal.1@4053.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/4053/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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.

Hospital & facility affiliations 8

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432944000000",
    "number": "1508955956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E WOODFIELD RD STE 113",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734786",
            "telephone_number": "847-686-6866",
            "fax_number": "847-706-9891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E WOODFIELD RD STE 113",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734786",
            "telephone_number": "847-686-6866",
            "fax_number": "847-706-9891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANSAL",
        "first_name": "TINA",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2015-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IL",
            "license": "036112667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION",
            "identifier": "202189914",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112667",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

Verify at the official NPI Registry.