NPIMap

Organization Active NPI

Chestnut Health of Illinois LLC

  • Internal Medicine Physician
  • Elgin, IL
National Provider Identifier
1588043939
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CHESTNUT HEALTH OF ILLINOIS LLC
Practice address
1530 N Randall Rd
Suite 200
Elgin, IL 60123-7877
Phone
(224) 760-7322
Fax
(224) 535-8252
NPI assigned
May 19, 2015
Last updated
May 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2022

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

Authorized official

Name
Omair Siraj
Title
Ceo
Phone
(703) 964-8199

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1530 N Randall Rd
Suite 200
Elgin, IL 60123-7877

Mailing address

PO Box 684
Bedford Park, IL 60499-0684
Phone (703) 964-8199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150819006369 IL Part B Supplier - Clinic/Group Practice 2264747344 Receives reassigned benefits from 67 practitioners

National Provider Directory

National Provider Directory

Locations

700 W Fabyan Pkwy
Batavia, IL 60510
Phone (630) 239-1133

151 W Terra Cotta Ave
Crystal Lake, IL 60014

430 30th Ave
East Moline, IL 61244
Phone (309) 755-3466

1400 Brookdale Rd
Naperville, IL 60563
Phone (610) 416-6565

515 N Main St
Sandwich, IL 60548
Phone (815) 786-8426

Practitioners & affiliated clinicians

Practitioners 74

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 74

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653609600000",
    "number": "1588043939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 684",
            "city": "BEDFORD PARK",
            "state": "IL",
            "postal_code": "604990684",
            "telephone_number": "703-964-8199",
            "fax_number": "703-649-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 N RANDALL RD",
            "address_2": "SUITE 200",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601237877",
            "telephone_number": "224-760-7322",
            "fax_number": "224-535-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTNUT HEALTH OF ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-19",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "SIRAJ",
        "authorized_official_first_name": "OMAIR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-964-8199"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.