Individual provider Active NPI

Andrew Mazulis, M.D.

  • Gastroenterology Physician
  • Libertyville, IL
National Provider Identifier
1699031583
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036-135984 Issued in IL
Practice address
825 S Milwaukee Ave
Libertyville, IL 60048-3218
Phone
(847) 573-2845
NPI assigned
Apr 5, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1699031583 IL
Gastroenterology Physician 207RG0100X 69801-20 WI
Gastroenterology Physician 207RG0100X 036-135984 IL Primary

Addresses

Primary practice location

825 S Milwaukee Ave
Libertyville, IL 60048-3218

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900

Other practice location 1

6308 8th Ave # 202
Kenosha, WI 53143-5031
Phone (262) 653-5330

Other identifiers 2

IdentifierTypeStateIssuer
69801-20OtherWILICENSE
1699031583MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address amazulis387463@direct.myadvocateaurora.org Direct

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
I20160613001104 IL Practitioner - GastroenterologyPractitioner - Internal Medicine 0042515595 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

825 S Milwaukee Ave
Libertyville, IL 60048-3218
Phone (847) 362-1393

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy175
Upper gastrointestinal (GI) endoscopy for acid reflux201

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1699031583ILMDInternal Medicine Physician
036-135984ILMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Nov 29, 2023 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 29, 2018 Accepting new patients
Best Practices Inpatient Care,LTD Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Internal Medicine CurrentSince Sep 29, 2018 Accepting new patients
Best Practices Inpatient Care, LTD. Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
The Medical College of Wisconsin, Inc. Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Advocate Health & Hospitals Corp. CurrentSince Nov 29, 2023 Accepting new patients
Froedtert South, Inc. CurrentSince Oct 1, 2018 Accepting new patients

Locations

800 W Central Rd
Arlington Hts, IL 60005
Phone (847) 618-6150

106 Barrington Commons Ct
Unit 1790
Barrington, IL 60011
Phone (847) 719-2220

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

755 S Milwaukee Ave
Ste 225
Libertyville, IL 60048
Phone (847) 573-2845

825 S Milwaukee Ave
Libertyville, IL 60048
Phone (847) 362-1393

450 W State Route 22
South Barrington, IL 60010
Phone (847) 381-0123

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

6308 8th Ave
#202
Kenosha, WI 53143
Phone (262) 653-5330

6308 8th Ave
Kenosha, WI 53143
Phone (262) 653-5300

W126N7338 Flint Dr
Ste 200
Menomonee Falls, WI 53051

9555 76th St
Pleasant Prairie, WI 53158
Phone (262) 577-8000

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

1700 W Paradise Dr
West Bend, WI 53095
Phone (262) 334-3451

Interoperability endpoints

  • Direct secure messaging: amazulis387463@direct.myadvocateaurora.org

Organizations & group practices 9

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 5

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": "1333584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1699031583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 S MILWAUKEE AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483218",
            "telephone_number": "847-573-2845"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6308 8th Ave # 202",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531435031",
            "country_code": "US",
            "telephone_number": "262-653-5330",
            "fax_number": "262-653-5346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAZULIS",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-05",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "1699031583",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WI",
            "license": "69801-20",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036-135984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "69801-20",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699031583",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "825 S Milwaukee Ave",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600483218",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amazulis387463@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "825 S Milwaukee Ave",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600483218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

Verify at the official NPI Registry.