Individual provider Active NPI

Zachary Beller

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1649023912
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125.084303 Issued in IL
Practice address
5841 S Maryland Ave Ste Mc7082
Chicago, IL 60637-1465
Phone
(773) 702-6840
Fax
(773) 702-2230
NPI assigned
Apr 8, 2024
Last updated
Jul 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 125.084303 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave Ste Mc7082
Chicago, IL 60637-1465

Mailing address

180 Harvester Dr Ste 110
Burr Ridge, IL 60527-6686
Phone (773) 702-1150

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
I20240715000555 IL Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 4183169147

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
125.084303ILMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1649023912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 HARVESTER DR STE 110",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276686",
            "telephone_number": "773-702-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE STE MC7082",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371465",
            "telephone_number": "773-702-6840",
            "fax_number": "773-702-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLER",
        "first_name": "ZACHARY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.084303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.