NPIMap

Individual provider Active NPI

Jerry Myrda, DO

  • Internal Medicine Physician
  • Elgin, IL
National Provider Identifier
1578564753
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036110352 Issued in IL
Practice address
2350 Royal Blvd Ste 300
Elgin, IL 60123-4718
Phone
(847) 742-3120
Fax
(847) 742-4021
NPI assigned
Aug 10, 2005
Last updated
Dec 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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 036110352 IL Primary

Addresses

Primary practice location

2350 Royal Blvd Ste 300
Elgin, IL 60123-4718

Mailing address

2350 Royal Blvd Suite 300
Elgin, IL 60123-4719
Phone (847) 742-3120

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address wintersfamilypractice@direct.myezyaccess.com Direct

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
I20040910001253 IL Practitioner - Internal Medicine 5294702130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
R Franklin University of Med & Sci/Chicago Medical School, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Winters Family Practice PCGroup PAC ID 0143232785, 5 clinicians

Practice addresses (Care Compare)

2350 Royal Blvd
Suite 300
Elgin, IL 60123-4718
Phone (847) 742-3120

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036110352ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Winters Family Practice PC CurrentSince Jun 1, 2008 Accepting new patients

Locations

2350 Royal Blvd
Ste 300
Elgin, IL 60123
Phone (847) 742-3120

Interoperability endpoints

  • Direct secure messaging: jerry.myrda.1@31804.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1578564753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 ROYAL BLVD SUITE 300",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601234719",
            "telephone_number": "847-742-3120",
            "fax_number": "847-742-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 ROYAL BLVD STE 300",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601234718",
            "telephone_number": "847-742-3120",
            "fax_number": "847-742-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYRDA",
        "first_name": "JERRY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036110352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2350 Royal Blvd Ste 300",
            "city": "Elgin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601234718",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wintersfamilypractice@direct.myezyaccess.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2350 Royal Blvd Ste 300",
            "city": "Elgin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601234718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

Verify at the official NPI Registry.