Individual provider Active NPI

Raid Abdulla, MD

  • Pediatric Cardiology Physician
  • Chicago, IL
National Provider Identifier
1710037742
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
036085177 Issued in IL
Practice address
1653 W Congress Pkwy
770 Jones
Chicago, IL 60612-3833
Phone
(312) 942-6800
Fax
(312) 942-6801
NPI assigned
Jan 11, 2007
Last updated
Apr 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-085177 IL
Pediatric Cardiology Physician 2080P0202X 036085177 IL Primary

Addresses

Primary practice location

1653 W Congress Pkwy
770 Jones
Chicago, IL 60612-3833

Mailing address

1653 W Congress Pkwy
770 Jones
Chicago, IL 60612-3833
Phone (312) 942-6800

Other identifiers 1

IdentifierTypeStateIssuer
036085177MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rabdulla@direct.ccprovider.org Direct Cook County

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
I20040909000850 IL Practitioner - Pediatric MedicinePractitioner - Cardiovascular Disease (Cardiology) 2668448663 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-085177ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Jun 1, 2014 Accepting new patients
The Board of Trustees of the University of Illinois Pediatrics CurrentSince Jun 1, 2014 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Lurie Children's Medical Group Inc Pediatrics CurrentSince Jan 1, 2019 Accepting new patients
Cook County Current Accepting new patients
Cook County CurrentSince Dec 22, 2010 Accepting new patients
Cook County CurrentSince Dec 22, 2010 Accepting new patients

Locations

Claims Remittance
Carol Stream, IL 60122

1653 W Congress Pkwy
Chicago, IL 60612
Phone (312) 942-3138

1653 W Congress Pkwy
#770
Chicago, IL 60612
Phone (312) 942-6003

1653 W Congress Pkwy
Ste 708
Chicago, IL 60612

1901 W Harrison St
Chicago, IL 60612

225 E Chicago Ave
Chicago, IL 60611
Phone (312) 227-4090

4909 W Division St
Chicago, IL 60651
Phone (773) 854-8000

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

737 N Michigan Ave
Ste 2040
Chicago, IL 60611

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-4210

840 S Wood St
#856
Chicago, IL 60612
Phone (312) 413-1429

2800 W 95th St
Evergreen Pk, IL 60805
Phone (708) 229-5104

Interoperability endpoints

  • Direct secure messaging: rabdulla@direct.ccprovider.org

Organizations & group practices 7

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": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1710037742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1653 W CONGRESS PKWY",
            "address_2": "770 JONES",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123833",
            "telephone_number": "312-942-6800",
            "fax_number": "312-942-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 W CONGRESS PKWY",
            "address_2": "770 JONES",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123833",
            "telephone_number": "312-942-6800",
            "fax_number": "312-942-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDULLA",
        "first_name": "RAID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-085177",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "IL",
            "license": "036085177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036085177",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rabdulla@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.