NPIMap

Individual provider Active NPI

Sandeep D. Mehta

  • Nephrology Physician
  • Highland Park, IL
National Provider Identifier
1558300319
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
036112471 Issued in IL
Practice address
1160 Park Ave W Ste 5N
Highland Park, IL 60035-2271
Phone
(847) 432-7222
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 036112471 IL Primary

Addresses

Primary practice location

1160 Park Ave W Ste 5N
Highland Park, IL 60035-2271

Mailing address

210 S Desplaines St
Chicago, IL 60661-5500
Phone (312) 654-2720

Other identifiers 1

IdentifierTypeStateIssuer
036112471MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smehta237064@direct.northshore.org

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
I20050418001068 IL Practitioner - NephrologyPractitioner - Internal Medicine 2567400849 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Associates in Nephrology SCGroup PAC ID 9133023963, 52 clinicians

Practice addresses (Care Compare)

101 Waukegan Rd
Suite 700
Lake Bluff, IL 60044-1687
Phone (847) 549-7222

1291 W Dundee Rd
Buffalo Grove, IL 60089-4009
Phone (847) 253-9400

15 Tower CT
Suite 240
Gurnee, IL 60031-3336
Phone (847) 432-7222

825 W 35TH St
Chicago, IL 60609-1511
Phone (312) 654-2744

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036112471ILMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Dec 21, 2015 Accepting new patients
Associates in Nephrology, S.C. Nephrology CurrentSince Apr 1, 2021 Accepting new patients
Endeavor Health Medical Group Current Accepting new patients
Endeavor Health Medical Group CurrentSince Feb 1, 2016 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Dec 21, 2015 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

9532 Eagle Way
Chicago, IL 60678

825 W 35th St
Chicago, IL 60609
Phone (773) 890-4330

4026 Paysphere Cir
Chicago, IL 60674

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

15 Tower Ct
Ste 240
Gurnee, IL 60031
Phone (847) 249-1606

767 Park Ave W
Ste 260
Highland Park, IL 60035
Phone (847) 432-7222

1160 Park Ave W
Ste 5N
Highland Park, IL 60035
Phone (847) 432-7222

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Interoperability endpoints

  • Direct secure messaging: smehta30868@direct.acumenmd.com

Organizations & group practices 5

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 10

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1558300319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S DESPLAINES ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606615500",
            "telephone_number": "312-654-2720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 PARK AVE W STE 5N",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600352271",
            "telephone_number": "847-432-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "SANDEEP",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036112471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112471",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smehta237064@direct.northshore.org",
            "affiliation": "N",
            "address_1": "767 Park Ave W Ste 260",
            "city": "Highland Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600352471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Highland Park, IL

Sources for this page

Verify at the official NPI Registry.