Individual provider Active NPI

Ilia S Panov, CRNA

  • Certified Registered Nurse Anesthetist
  • Libertyville, IL
National Provider Identifier
1588800296
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209007349 Issued in IL
Practice address
801 S Milwaukee Ave
Libertyville, IL 60048-3204
Phone
(847) 362-2905
NPI assigned
Dec 30, 2008
Last updated
Jul 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 209007349 IL Primary

Addresses

Primary practice location

801 S Milwaukee Ave
Libertyville, IL 60048-3204

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ipanov238072@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090127000469 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8325102965 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Rush Medical College of Rush University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Gastroenterology Group LLCGroup PAC ID 5193857423, 116 clinicians

Practice addresses (Care Compare)

101 S Waukegan Rd
Suite 980
Lake Bluff, IL 60044-3013
Phone (847) 604-8700

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

801 S Milwaukee Ave
Libertyville, IL 60048-3204
Phone (847) 279-0061

801 S Milwaukee Ave BLDG
Suite 880
Libertryville, IL 60048-3204
Phone (847) 990-5910

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
209007349ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Gastroenterology Group, LLC CurrentSince Jul 8, 2011 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jun 6, 2024 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Northwest Gastroenterologists SC Current Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Jun 6, 2024 Accepting new patients
Elgin Gastroenterology SC Current Accepting new patients
Elgin Gastroenterology Endoscopy Center LLC Current Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

2900 N Lakeshore
Chicago, IL 60657
Phone (773) 665-3240

29373 Network Pl
Chicago, IL 60673

745 Fletcher Dr
Ste 202
Elgin, IL 60123
Phone (855) 483-7362

101 Waukegan Rd
Lake Bluff, IL 60044
Phone (847) 604-8700

101 Waukegan Rd
Ste 980
Lake Bluff, IL 60044
Phone (847) 457-1060

801 S Milwaukee Ave
Libertyville, IL 60048
Phone (847) 362-2900

900 Garfield Ave
Libertyville, IL 60048
Phone (847) 362-2900

2550 W Algonquin Rd
Lk in the Hls, IL 60156
Phone (847) 458-1246

1775 W Dempster St
Park Ridge, IL 60068
Phone (847) 723-5150

1324 N Sheridan Rd
Waukegan, IL 60085
Phone (847) 360-3000

Interoperability endpoints

  • Direct secure messaging: ipanov238072@direct.myadvocateaurora.org

Organizations & group practices 8

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 3

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": "1230595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1588800296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S MILWAUKEE AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483204",
            "telephone_number": "847-362-2905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANOV",
        "first_name": "ILIA",
        "middle_name": "S",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-30",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209007349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ipanov238072@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "801 S Milwaukee Ave",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600483204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "801 S Milwaukee Ave",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600483204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.