NPIMap

Individual provider Active NPI

Michael Andrew Havens, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Chicago, IL
National Provider Identifier
1619128923
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
036120021 Issued in IL
Practice address
6528 N Olympia Ave
Chicago, IL 60631-1520
Phone
(773) 792-8112
NPI assigned
Oct 6, 2008
Last updated
Jan 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X 036120021 IL
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 036120021 IL Primary

Addresses

Primary practice location

6528 N Olympia Ave
Chicago, IL 60631-1520

Mailing address

1000 N Westmoreland Rd # Ll0519
Lake Forest, IL 60045-1658
Phone (847) 535-6218

Other practice location 1

1475 E Belvidere Rd Dept 1134
Grayslake, IL 60030-2085
Phone (847) 535-6119

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
I20090914000598 IL Practitioner - Pathology 8921154196 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Rush Medical College of Rush University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10400 Haligus Rd
Lowr Level
Huntley, IL 60142-9553
Phone (224) 654-0800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036120021ILMDCytopathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jun 1, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jun 1, 2023 Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

1475 E Belvidere Rd
#1134
Grayslake, IL 60030
Phone (847) 535-6119

10400 Haligus Rd
Lowr
Huntley, IL 60142
Phone (224) 654-0800

1000 N Westmoreland Rd
#519
Lake Forest, IL 60045
Phone (847) 535-6218

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

Organizations & group practices 3

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 4

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": "1223251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1619128923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N WESTMORELAND RD # LL0519",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451658",
            "telephone_number": "847-535-6218",
            "fax_number": "847-535-6237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6528 N OLYMPIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606311520",
            "telephone_number": "773-792-8112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1475 E Belvidere Rd Dept 1134",
            "address_purpose": "LOCATION",
            "city": "Grayslake",
            "state": "IL",
            "postal_code": "600302085",
            "country_code": "US",
            "telephone_number": "847-535-6119",
            "fax_number": "847-535-6237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAVENS",
        "first_name": "MICHAEL",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-06",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "IL",
            "license": "036120021",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036120021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.