NPIMap

Individual provider Active NPI

Herve Y Sroussi

  • Dentist
  • Chicago, IL
National Provider Identifier
1659455772
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DF11247 Issued in MA
Practice address
1740 W Taylor St
Chicago, IL 60612-7232
Phone
(866) 600-2273
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 136-000107 IL
Dentist 122300000X DF11247 MA Primary

Addresses

Primary practice location

1740 W Taylor St
Chicago, IL 60612-7232

Mailing address

809 S Marshfield Ave
9TH Floor (M/C 732)
Chicago, IL 60612-4305
Phone (312) 996-7699

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20170731000796 MA Practitioner - Dentist 6507178530 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Univ of Illinois at Chicago College of Dentistry, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dana-Farber Cancer Institute, Inc.Group PAC ID 9133038904, 671 clinicians
Brigham and Womens Physicians Organization IncGroup PAC ID 3870405988, 2,931 clinicians
Brigham and Womens Hospital IncGroup PAC ID 4385554732, 52 clinicians

Practice addresses (Care Compare)

450 Brookline Ave
Boston, MA 02215-5418
Phone (617) 632-3586

51 Performance Dr
Weymouth, MA 02189-3141
Phone (781) 534-7700

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Hospital & facility affiliations

  • Brigham and Women'S Hospital Hospital, Boston, MA, CCN 220110
  • Dana-Farber Cancer Institute Hospital, Boston, MA, CCN 220162
  • Brigham and Women Faulkner Hospital Hospital, Jamaica Plain, MA, CCN 220119

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
136-000107ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham & Womens Physicians Organization Inc CurrentSince Dec 14, 2022 Accepting new patients
Brigham & Womens Hospital, Inc. CurrentSince Jun 18, 2017 Accepting new patients
Brigham and Women'S Hospital Current Accepting new patients
Dana-Farber Cancer Institute, Inc. CurrentSince Aug 9, 2017 Accepting new patients
Dana-Farber Cancer Institute, Inc. CurrentSince Aug 9, 2017 Accepting new patients
Brigham and Womens Physicians Organization Inc Past Accepting new patients

Locations

75 Francis St
Boston, MA 02115

450 Brookline Ave
Boston, MA 02215
Phone (508) 478-2061

375 Boylston St
Brookline, MA 02445
Phone (508) 718-4010

399 Revolution Dr
Somerville, MA 02145
Phone (800) 856-1983

51 Performance Dr
Weymouth, MA 02189
Phone (781) 337-5555

Interoperability endpoints

  • Direct secure messaging: sroussi.herve.bwh@direct.partners.masshiway.net

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.

Hospital & facility affiliations 4

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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1659455772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 S MARSHFIELD AVE",
            "address_2": "9TH FLOOR (M/C 732)",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124305",
            "telephone_number": "312-996-7699",
            "fax_number": "312-996-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127232",
            "telephone_number": "866-600-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SROUSSI",
        "first_name": "HERVE",
        "middle_name": "Y",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "136-000107",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DF11247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.