Active NPI
Theodore T. Faber, M.D.
- Neurology Physician
- Chicago, IL
National Provider Identifier
1558372995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 14276
- Practice address
- 2045 W Grand Ave
Chicago, IL 60612-1576 - Phone
- (086) 301-5347
- NPI assigned
- Aug 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 14276 | SC | Primary |
Addresses
Primary practice location
2045 W Grand Ave
Chicago, IL 60612-1576
Mailing address
2045 W Grand Ave Ste B
Chicago, IL 60612-1577
Phone (708) 630-1534
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142768 | Medicaid | SC | |
| E137269482 | Other | SC | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC, AL, NJ, IL, VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 5
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14276 | SC | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Syntrillo Health PC | Neurology | Current | Accepting new patients |
| South Carolina Neurological Clinic PA | Neurology | Past | Accepting new patients |
| Access Telecare, PLLC | Neurology | Past | Accepting new patients |
| University Specialty Clinics - Ophthalmology | Past | Accepting new patients | |
| University Specialty Clinics - Neurology | Neurology | Past | Accepting new patients |
Locations
240 W Main St
Ste 100CW113
Charlottesville, VA 22902
Phone (434) 202-3450
Interoperability endpoints
- tfaber181910@direct.llu.edu
- tfaber59224@epicdirect.rwjbh.org
- tfaber533671@direct.umm.edu
Organizations & group practices 9
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.
-
- Neurology Physician
- Charlottesville, VA
- NPI 1205693140
-
- Neurology Physician
- Charlottesville, VA
- NPI 1740168533
-
- Neurology Physician
- Columbia, SC
- NPI 1821009077
-
- Neurology Physician
- Columbia, SC
- NPI 1457675621
-
- Ophthalmology Physician
- Columbia, SC
- NPI 1275561771
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662595200000",
"number": "1558372995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2045 W GRAND AVE STE B",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606121577",
"telephone_number": "708-630-1534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2045 W GRAND AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606121576",
"telephone_number": "086-301-5347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FABER",
"first_name": "THEODORE",
"middle_name": "T.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2022-09-08",
"certification_date": "2022-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "SC",
"license": "14276",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "142768",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "E137269482",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.