Individual provider Active NPI

Ashokmathew T Poozhikunnel

  • Internal Medicine Physician
  • Des Plaines, IL
National Provider Identifier
1710418892
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-163643 Issued in IL
Practice address
77 Rand Rd
Des Plaines, IL 60016-1005
Phone
(847) 298-0310
Fax
(847) 298-5939
NPI assigned
Mar 21, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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 73188 WI
Internal Medicine Physician 207R00000X 036-163643 IL Primary

Addresses

Primary practice location

77 Rand Rd
Des Plaines, IL 60016-1005

Mailing address

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

Other practice location 1

3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100

Electronic endpoints 4

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address apoozhikunnel279615@direct.myadvocateaurora.org Direct
Direct Messaging Address apoozhikunnel279615@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200722000531 WI Practitioner - Internal Medicine 3971873829
I20230322000405 IL Practitioner - Internal Medicine 3971873829 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Chicago College of Osteopathy, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advocate Health and Hospitals CorporationGroup PAC ID 7810800935, 3,081 clinicians

Practice addresses (Care Compare)

77 Rand Rd
Des Plaines, IL 60016-1005
Phone (847) 294-5490

Hospital & facility affiliations

  • Advocate Home Health Care Serv Home health agency, Oakbrook, IL, CCN 147150
  • Advocate Lutheran General Hospital Hospital, Park Ridge, IL, CCN 140223

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73188WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health & Hospitals Corporation CurrentSince Apr 8, 2023 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Apr 8, 2023 Accepting new patients

Locations

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

29373 Network Pl
Chicago, IL 60673

77 Rand Rd
Des Plaines, IL 60016
Phone (847) 294-5490

1775 Ballard Rd
Park Ridge, IL 60068
Phone (847) 318-6020

Interoperability endpoints

  • Direct secure messaging: apoozhikunnel279615@direct.myadvocateaurora.org

Organizations & group practices 3

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 2

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": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1710418892",
    "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": "77 RAND RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161005",
            "telephone_number": "847-298-0310",
            "fax_number": "847-298-5939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3003 W Good Hope Rd",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532092042",
            "country_code": "US",
            "telephone_number": "414-352-3100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POOZHIKUNNEL",
        "first_name": "ASHOKMATHEW",
        "middle_name": "T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-21",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "73188",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-163643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3003 W Good Hope Rd",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532092042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apoozhikunnel279615@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3003 W Good Hope Rd",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532092042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apoozhikunnel279615@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "77 Rand Rd",
            "city": "Des Plaines",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600161005",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "77 Rand Rd",
            "city": "Des Plaines",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600161005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

Verify at the official NPI Registry.