Individual provider Active NPI

Rehan Ahmed Nizamuddin, M.D.

  • Diagnostic Radiology Physician
  • Evanston, IL
National Provider Identifier
1619322252
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036156032 Issued in IL
Practice address
2650 Ridge Ave
Suite 1304
Evanston, IL 60201-1718
Phone
(224) 639-6624
NPI assigned
May 2, 2016
Last updated
Apr 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125068937 IL
Diagnostic Radiology Physician 2085R0202X 2018014985 MO
Diagnostic Radiology Physician 2085R0202X 036156032 IL Primary

Addresses

Primary practice location

2650 Ridge Ave
Suite 1304
Evanston, IL 60201-1718

Mailing address

2650 Ridge Ave.
Dept. of Radiology
Evanston, IL 60201-1057
Phone (847) 570-2477

Other practice location 1

676 N Saint Clair St Ste 800
Chicago, IL 60611-2978
Phone (312) 695-5753

Other practice location 2

1 Barnes Jewish Hospital Plz
Saint Louis, MO 63110-1003
Phone (314) 362-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210624002554 IL Practitioner - Diagnostic Radiology 3476845009 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Missouri, Kansas City, School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Suite 2218a
Evanston, IL 60201-1700
Phone (847) 503-4222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036156032ILMDDiagnostic Radiology Physician
2018014985MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Jun 1, 2022 Accepting new patients
Northwestern Medical Faculty Foundation Diagnostic Radiology CurrentSince Jul 1, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2021 Accepting new patients
Endeavor Health Medical Group Family Medicine CurrentSince Jun 1, 2022 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

676 N Saint Clair St
Ste 1725
Chicago, IL 60611
Phone (312) 664-8533

676 N Saint Clair St
Ste 800
Chicago, IL 60611
Phone (312) 695-5753

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 1304
Evanston, IL 60201
Phone (847) 570-2700

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 4

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 6

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": "1462147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1619322252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE.",
            "address_2": "DEPT. OF RADIOLOGY",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011057",
            "telephone_number": "847-570-2477",
            "fax_number": "847-570-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "SUITE 1304",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "224-639-6624"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "676 N Saint Clair St Ste 800",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606112978",
            "country_code": "US",
            "telephone_number": "312-695-5753",
            "fax_number": "312-695-5645",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Barnes Jewish Hospital Plz",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101003",
            "country_code": "US",
            "telephone_number": "314-362-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIZAMUDDIN",
        "first_name": "REHAN",
        "middle_name": "AHMED",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-02",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125068937",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2018014985",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036156032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.