NPIMap

Individual provider Active NPI

Aleksandr Podolskiy, MD

  • Family Medicine Physician
  • Libertyville, IL
National Provider Identifier
1619922135
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036111753 Issued in IL
Practice address
755 S Milwaukee Ave
Suite 164
Libertyville, IL 60048
Phone
(847) 918-0430
Fax
(847) 918-7850
NPI assigned
May 23, 2006
Last updated
Dec 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036111753 IL Primary

Addresses

Primary practice location

755 S Milwaukee Ave
Suite 164
Libertyville, IL 60048

Mailing address

PO Box 5979
Buffalo Grove, IL 60089-5979

Other identifiers 1

IdentifierTypeStateIssuer
036111753MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address apodolskiy235742@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
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
I20041018001126 IL Practitioner - Family Practice 7810957321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
A Podolskiy MD SCGroup PAC ID 5496768285, 2 clinicians

Practice addresses (Care Compare)

755 S Milwaukee Ave
Suite 164
Libertyville, IL 60048-3267
Phone (847) 918-0430

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036111753ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
A Podolskiy MD SC Family Medicine CurrentSince Jul 3, 2006 Accepting new patients
A. Podolskiy, MD, SC Family Medicine Past Accepting new patients
Yury M Shklyar MD PC Family Medicine PastSince Jul 18, 2000 Accepting new patients
Aaa Headache and Pain Clinic LTD Past Accepting new patients

Locations

755 S Milwaukee Ave
Ste 164
Libertyville, IL 60048
Phone (847) 247-0187

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 12

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1619922135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5979",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600895979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 S MILWAUKEE AVE",
            "address_2": "SUITE 164",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "60048",
            "telephone_number": "847-918-0430",
            "fax_number": "847-918-7850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PODOLSKIY",
        "first_name": "ALEKSANDR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036111753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111753",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apodolskiy235742@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "755 s milwaukee ave",
            "address_2": "suite 164",
            "city": "libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60048",
            "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": "755 s milwaukee ave",
            "address_2": "suite 164",
            "city": "libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

Verify at the official NPI Registry.