Individual provider Active NPI

Ruta Pangonyte

  • Family Medicine Physician
  • Des Plaines, IL
National Provider Identifier
1710549415
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036162703 Issued in IL
Practice address
9301 Golf Rd
Des Plaines, IL 60016-1667
Phone
(847) 982-3172
Fax
(847) 296-3915
NPI assigned
Jul 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125.07502 IL
Family Medicine Physician 207Q00000X 036162703 IL Primary

Addresses

Primary practice location

9301 Golf Rd
Des Plaines, IL 60016-1667

Mailing address

2108 Webster LN
Des Plaines, IL 60018-2725

Other practice location 1

1500 s california st
chicago, IL 60608-6001
Phone (312) 952-2897

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
I20230123000832 IL Practitioner - Family Practice 8123499506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Evanston, IL 60201-1700

9301 Golf Rd
Suite 302
Des Plaines, IL 60016-7900
Phone (847) 296-8151

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.07502ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Family Medicine CurrentSince Jan 9, 2023 Accepting new patients
Endeavor Health Medical Group CurrentSince Jan 9, 2023 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

9301 Golf Rd
Ste 302
Des Plaines, IL 60016
Phone (708) 296-8151

9301 Golf Rd
Des Plaines, IL 60016
Phone (847) 296-8151

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

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.

Hospital & facility affiliations 6

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": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1710549415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 WEBSTER LN",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600182725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9301 GOLF RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161667",
            "telephone_number": "847-982-3172",
            "fax_number": "847-296-3915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 s california st",
            "address_purpose": "LOCATION",
            "city": "chicago",
            "state": "IL",
            "postal_code": "606086001",
            "country_code": "US",
            "telephone_number": "312-952-2897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANGONYTE",
        "first_name": "RUTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-02",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125.07502",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036162703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

Verify at the official NPI Registry.