NPIMap

Individual provider Active NPI

Keith M Lertsburapa, M.D.

  • Otolaryngology Physician
  • Hinsdale, IL
National Provider Identifier
1538318308
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
036.127737 Issued in IL
Practice address
11 Salt Creek LN Ste 101
Hinsdale, IL 60521-3032
Phone
(630) 789-3110
NPI assigned
Sep 16, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 036.127737 IL Primary

Addresses

Primary practice location

11 Salt Creek LN Ste 101
Hinsdale, IL 60521-3032

Mailing address

11 Salt Creek LN Ste 101
Hinsdale, IL 60521-3032
Phone (630) 789-3110

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address keith.lertsburapa.1@380.direct.athenahealth.com

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
I20110720000174 IL Practitioner - Otolaryngology 7911175898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adventist Health Partners, Inc.Group PAC ID 0244135762, 253 clinicians

Practice addresses (Care Compare)

120 N Oak St
Hinsdale, IL 60521-3829
Phone (630) 856-9000

15728 S Route 59
Plainfield, IL 60544-2693
Phone (815) 436-8831

396 Remington Blvd
Bolingbrook, IL 60440-4311

630 E N Ave
Carol Stream, IL 60188-2127
Phone (630) 458-5300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.127737ILMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Partners, Inc. Current Accepting new patients
Adventist Health Partners, Inc CurrentSince Apr 29, 2011 Accepting new patients
Adventist Health Partners,Inc CurrentSince Apr 29, 2011 Accepting new patients
Adventist Health Partners,Inc Past Accepting new patients

Locations

396 Remington Blvd
Ste 231
Bolingbrook, IL 60440
Phone (630) 312-4301

630 E North Ave
Carol Stream, IL 60188
Phone (630) 458-5300

5207 Main St
Ste 5
Downers Grove, IL 60515
Phone (630) 981-0032

11 Salt Creek Ln
Ste 101
Hinsdale, IL 60521
Phone (630) 789-3110

15728 S Route 59
Plainfield, IL 60544
Phone (815) 436-8831

2363 63rd St
Woodridge, IL 60517
Phone 22477355880000

Interoperability endpoints

  • Direct secure messaging: klertsburapa1240443@adventhealth.direct-ci.com

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.

Hospital & facility affiliations 9

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": "1221523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1538318308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 SALT CREEK LN STE 101",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605213032",
            "telephone_number": "630-789-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 SALT CREEK LN STE 101",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605213032",
            "telephone_number": "630-789-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LERTSBURAPA",
        "first_name": "KEITH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-16",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036.127737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "keith.lertsburapa.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "11 Salt Creek Ln Ste 101",
            "city": "Hinsdale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605213032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hinsdale, IL

Sources for this page

Verify at the official NPI Registry.