Zachary Beller
Individual provider Active NPI Internal Medicine Physician · Chicago, IL
NPI 1649023912 · NPPES record last updated Jul 25, 2024
Key facts
- NPI
- 1649023912
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 125.084303 (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
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240715000555 | IL | Order and Referring Only - Internal Medicine |
4183169147 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.084303 | IL | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 125.084303 | IL | Yes |
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
NPI Registry JSON
{
"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
- John P Bellen
- Mark Bellen
- Wayne Bellen
- Eli Beller
- Ina Beller
- Gina Belli
- Rosa Bellido-Griffin
- Natalie E. Belling
- Giorgiana Bellisario
- Maria Camila Bello Torres
All providers in Chicago, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.