Individual provider Active NPI

Edward Charles Villa, M.D.

  • Gastroenterology Physician
  • Chicago, IL
National Provider Identifier
1639435209
Registry record updated Jun 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036.137394 Issued in IL
Practice address
840 S Wood St
Suite 718E CSB, MC 716
Chicago, IL 60612
Phone
(312) 996-6652
NPI assigned
Apr 7, 2012
Reactivated
Oct 4, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036.137394 IL
Gastroenterology Physician 207RG0100X 036.137394 IL Primary

Addresses

Primary practice location

840 S Wood St
Suite 718E CSB, MC 716
Chicago, IL 60612

Mailing address

235 W Van Buren St
Unit 2108
Chicago, IL 60607-3918
Phone (847) 668-3875

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
I20150625002444 IL Practitioner - GastroenterologyPractitioner - Internal Medicine 6507177961 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Loyola University of Chicago, Stritch School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
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

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
  • Swedish Hospital Hospital, Chicago, IL, CCN 140114

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy89
Upper gastrointestinal (GI) endoscopy for acid reflux471

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.137394ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Jul 16, 2019 Accepting new patients
The Board of Trustees of the University of Illinois Internal Medicine CurrentSince Jul 16, 2019 Accepting new patients
Endeavor Health Medical Group Internal Medicine CurrentSince Jun 25, 2015 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Endeavor Health Medical Group CurrentSince Jun 25, 2015 Accepting new patients

Locations

840 S Wood St
Ste 718E
Chicago, IL 60612
Phone (312) 996-0141

9532 Eagle Way
Chicago, IL 60678

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

840 S Wood St
Chicago, IL 60612
Phone (312) 996-6711

845 W Wilson Ave
Chicago, IL 60640
Phone (312) 744-1295

835 S Wolcott Ave
Rm W140
Chicago, IL 60612

7732 Solutions Ctr
Chicago, IL 60677

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

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

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

1000 Central St
Ste 800
Evanston, IL 60201
Phone (847) 570-2503

Interoperability endpoints

  • Direct secure messaging: evilla17779@uihealth.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1333756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561593600000",
    "number": "1639435209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 W VAN BUREN ST",
            "address_2": "UNIT 2108",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606073918",
            "telephone_number": "847-668-3875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 S WOOD ST",
            "address_2": "SUITE 718E CSB, MC 716",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-996-6652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLA",
        "first_name": "EDWARD",
        "middle_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-07",
        "last_updated": "2019-06-27",
        "deactivation_date": "2018-07-02",
        "reactivation_date": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.137394",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036.137394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.