Individual provider Active NPI

Charlotte Louise Kvasnovsky, MD, MPH

  • Pediatric Surgery Physician
  • Baltimore, MD
National Provider Identifier
1639481476
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
036-162303 Issued in IL
Practice address
827 Saint Paul St
Floor 4
Baltimore, MD 21202-2405
Phone
(240) 383-2157
NPI assigned
Jul 9, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X 036-162303 IL Primary

Addresses

Primary practice location

827 Saint Paul St
Floor 4
Baltimore, MD 21202-2405

Mailing address

827 Saint Paul St
Floor 4
Baltimore, MD 21202-2405
Phone (240) 383-2157

Other practice location 1

1675 Dempster St Fl 3
Park Ridge, IL 60068-1110
Phone (773) 702-6175

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ckvasnosky353667@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: 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
I20221202002879 IL Practitioner - Pediatric Medicine 8325347545 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-162303ILMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation Current Accepting new patients
The University of Chicago Medical Center CurrentSince Oct 1, 2022 Accepting new patients
The University of Chicago Medical Center CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Oct 22, 2022 Accepting new patients
University of Chicago CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health & Hospitals Corp. CurrentSince Oct 22, 2022 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

29373 Network Pl
Chicago, IL 60673

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

1675 W Dempster St
Fl 3
Park Ridge, IL 60068
Phone (847) 318-9330

Interoperability endpoints

  • Direct secure messaging: ckvasnovsky244775@uchospital.direct-ci.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1639481476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "827 SAINT PAUL ST",
            "address_2": "FLOOR 4",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022405",
            "telephone_number": "240-383-2157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 SAINT PAUL ST",
            "address_2": "FLOOR 4",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022405",
            "telephone_number": "240-383-2157"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1675 Dempster St Fl 3",
            "address_purpose": "LOCATION",
            "city": "Park Ridge",
            "state": "IL",
            "postal_code": "600681110",
            "country_code": "US",
            "telephone_number": "773-702-6175",
            "fax_number": "847-723-5615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KVASNOVSKY",
        "first_name": "CHARLOTTE",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-09",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "IL",
            "license": "036-162303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ckvasnosky353667@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1675 Dempster St Fl 3",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681110",
            "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": "1675 Dempster St Fl 3",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.