Shubhrajan S Wadyal, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036-135143 Issued in IL

Practice address

1786 Moon Lake Blvd
Suite 104
Hoffman Estates, IL 60169-5029

Phone

(847) 755-8090

Fax

(847) 843-7393

NPI assigned

May 16, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Psychiatry

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Alexian Brothers Behavioral Health HospitalGroup PAC ID 9537062138, 55 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: shubhrajan.wadyal.1@15182.direct.athenahealth.com

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.

• Alexian Brothers Behavioral Health Hospital

  • Psychiatry Physician
  • Hoffman Estates, IL
  • NPI 1801318928
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1710144837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1786 MOON LAKE BLVD",
            "address_2": "SUITE 104",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601695029",
            "telephone_number": "847-755-8090",
            "fax_number": "847-843-7393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1786 MOON LAKE BLVD",
            "address_2": "SUITE 104",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601695029",
            "telephone_number": "847-755-8090",
            "fax_number": "847-843-7393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADYAL",
        "first_name": "SHUBHRAJAN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-16",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036-135143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50986",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Hoffman Estates, IL
• Providers in Hoffman Estates, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.