Individual provider Active NPI

Fatema M Photowala, MD

  • Pulmonary Disease Physician
  • Aurora, IL
National Provider Identifier
1669674610
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
036-115996 Issued in IL
Practice address
1221 N Highland Ave
Aurora, IL 60506-1404
Phone
(630) 859-8700
NPI assigned
Jun 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 036-115996 IL Primary
Student in an Organized Health Care Education/Training Program 390200000X 36115996 IL

Addresses

Primary practice location

1221 N Highland Ave
Aurora, IL 60506-1404

Mailing address

28594 Network PL
Chicago, IL 60673-1285
Phone (630) 859-6800

Other identifiers 2

IdentifierTypeStateIssuer
04515143OtherILBCBS#
036115996MedicaidIL

Other names 1

  • Fatema M Bahrainwala Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address fphotowala206423@direct.myadvocateaurora.org
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
I20110104000524 IL Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 8527257732 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1221 N Highland Ave
Aurora, IL 60506-1404
Phone (630) 859-6800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-115996ILMDPulmonary Disease Physician
36115996ILMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients
Midwest Sleep Associates, LLC Past Accepting new patients

Locations

2357 Sequoia Dr
Aurora, IL 60506
Phone (630) 859-6700

1221 N Highland Ave
Aurora, IL 60506
Phone (630) 859-6700

28594 Network Pl
Chicago, IL 60673

Organizations & group practices 4

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": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666310400000",
    "number": "1669674610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28594 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731285",
            "telephone_number": "630-859-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 N HIGHLAND AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605061404",
            "telephone_number": "630-859-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOTOWALA",
        "first_name": "FATEMA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-01",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036-115996",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "36115996",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS#",
            "identifier": "04515143",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036115996",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fphotowala206423@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "1221 N Highland Ave",
            "city": "Aurora",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605061404",
            "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": "1221 N Highland Ave",
            "city": "Aurora",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605061404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "FATEMA",
            "last_name": "BAHRAINWALA",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Aurora, IL

Sources for this page

Verify at the official NPI Registry.