NPIMap

Organization Active NPI

Andrew Agen Davis, MD SC

  • Cardiovascular Disease Physician
  • Chicago, IL
National Provider Identifier
1598869224
Registry record updated Feb 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036054434 Issued in IL
Legal business name
ANDREW AGEN DAVIS, MD SC
Practice address
8541 So State Street
Suite 8
Chicago, IL 60619
Phone
(773) 874-7711
Fax
(773) 874-4721
NPI assigned
Sep 12, 2006
Last updated
Feb 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2015

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

Authorized official

Name
Andrew Agen Davis, MDNPI 1245247634
Title
President
Phone
(773) 874-7711

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036054434 IL Primary

Addresses

Primary practice location

8541 So State Street
Suite 8
Chicago, IL 60619

Mailing address

8541 South State Street
Suite 8
Chicago, IL 60619
Phone (773) 874-7711

Other identifiers 1

IdentifierTypeStateIssuer
036054434MedicaidIL

Other names 1

  • Andy Agen Davis, MD SC Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423180800000",
    "number": "1598869224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8541 SOUTH STATE STREET",
            "address_2": "SUITE 8",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60619",
            "telephone_number": "773-874-7711",
            "fax_number": "773-874-4721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8541 SO STATE STREET",
            "address_2": "SUITE 8",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60619",
            "telephone_number": "773-874-7711",
            "fax_number": "773-874-4721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREW AGEN DAVIS, MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2015-02-06",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "AGEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-874-7711",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036054434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036054434",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Andy Agen Davis, MD SC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.