Active NPI
Desmond B McDonagh, MD
- Vascular Surgery Physician
- Gurnee, IL
National Provider Identifier
1699734186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 036046231
- Practice address
- 1790 Nations Dr
Suite #207
Gurnee, IL 60031-9164 - Phone
- (847) 205-9900
- Fax
- (847) 205-9905
- NPI assigned
- Mar 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 036046231 | IL | Primary |
| Phlebology Physician | 202K00000X | 036-046231 | IL |
Addresses
Primary practice location
1790 Nations Dr
Suite #207
Gurnee, IL 60031-9164
Mailing address
1901 Butterfield Rd
Ste 220
Downers Grove, IL 60515-7915
Phone (630) 725-2768
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01622308 | Other | IL | BXBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-046231 | IL | MD | Phlebology Physician |
| 036046231 | IL | MD | Vascular Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illinois Phlebology Associates SC | Phlebology | Past | Accepting new patients |
| Vein Clinics of Chicago LLC | Vascular Surgery | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Vascular Surgery Physician
- Chicago, IL
- NPI 1386904621
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1699734186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 BUTTERFIELD RD",
"address_2": "STE 220",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "605157915",
"telephone_number": "630-725-2768",
"fax_number": "630-725-2783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1790 NATIONS DR",
"address_2": "SUITE #207",
"city": "GURNEE",
"state": "IL",
"postal_code": "600319164",
"telephone_number": "847-205-9900",
"fax_number": "847-205-9905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONAGH",
"first_name": "DESMOND",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-22",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "IL",
"license": "036046231",
"primary": true
},
{
"code": "202K00000X",
"taxonomy_group": "",
"desc": "Phlebology",
"state": "IL",
"license": "036-046231",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BXBS",
"identifier": "01622308",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gurnee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.