NPIMap

Individual provider Active NPI

Chool Liyanapatabendi, MD

  • Internal Medicine Physician
  • Park Ridge, IL
National Provider Identifier
1689976649
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036.128738 Issued in IL
Practice address
1875 Dempster St Ste 180
Park Ridge, IL 60068-1144
Phone
(630) 366-6681
Fax
(888) 624-2470
NPI assigned
Nov 24, 2010
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125055608 IL
Internal Medicine Physician 207R00000X 036.128738 IL Primary

Addresses

Primary practice location

1875 Dempster St Ste 180
Park Ridge, IL 60068-1144

Mailing address

561 N Howard Ave
Elmhurst, IL 60126-2024
Phone (630) 607-1253

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20120618000672 IL Practitioner - Internal Medicine 0941464242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

715 W Lake St
Suite 104
Addison, IL 60101-2082
Phone (630) 366-6681

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.128738ILMDInternal Medicine Physician
125055608ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center Current Accepting new patients
Amenity Health Care Inc CurrentSince Feb 5, 2024 Accepting new patients
Longevity Clinical LTC Associates of Illinois PLLC PastSince May 28, 2021 Accepting new patients
Elmbrook Skilled Nursing Facility LLC PastSince Nov 6, 2015 Accepting new patients

Locations

715 W Lake St
Ste 104
Addison, IL 60101
Phone (630) 366-6681

715 W Lake St
Ste 202
Addison, IL 60101
Phone (630) 366-6424

Interoperability endpoints

  • Direct secure messaging: cliyanapatabendi40660@direct.luhs.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Grove of ElmhurstElmhurst, IL, CCN 145339 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 6, 2015
Nov 6, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1290556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1689976649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "561 N HOWARD AVE",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601262024",
            "telephone_number": "630-607-1253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 DEMPSTER ST STE 180",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681144",
            "telephone_number": "630-366-6681",
            "fax_number": "888-624-2470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIYANAPATABENDI",
        "first_name": "CHOOL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125055608",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.128738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.