Individual provider Active NPI

Jelveh Jahangiri, MD

  • Internal Medicine Physician
  • Hines, IL
National Provider Identifier
1679676522
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036099249 Issued in IL
Practice address
1200 South First Ave
Hines, IL 60141-7000
Phone
(708) 338-7048
Fax
(708) 338-7233
NPI assigned
Sep 6, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036099249 IL Primary

Addresses

Primary practice location

1200 South First Ave
Hines, IL 60141-7000

Mailing address

1200 South First Ave
Hines, IL 60141-7000
Phone (708) 338-7048

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
I20120508000760 IL Practitioner - Internal Medicine 9436311487 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036099249ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Department of Human Services Current Accepting new patients
Illinois Department of Human Services CurrentSince Jun 16, 2016 Accepting new patients
Illinois Department of Human Services CurrentSince Jun 16, 2016 Accepting new patients

Locations

134 W Main St
Dwight, IL 60420
Phone (815) 584-3347

100 S Grand Ave E
Springfield, IL 62762

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679676522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SOUTH FIRST AVE",
            "city": "HINES",
            "state": "IL",
            "postal_code": "601417000",
            "telephone_number": "708-338-7048",
            "fax_number": "708-338-7233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SOUTH FIRST AVE",
            "city": "HINES",
            "state": "IL",
            "postal_code": "601417000",
            "telephone_number": "708-338-7048",
            "fax_number": "708-338-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAHANGIRI",
        "first_name": "JELVEH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036099249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hines, IL

Sources for this page

Verify at the official NPI Registry.