Individual provider Active NPI

Brian Ralston, MD

  • Family Medicine Physician
  • Berwyn, IL
National Provider Identifier
1710917109
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-088397 Issued in IL
Practice address
3231 Euclid Ave FL 5
Berwyn, IL 60402-4603
Phone
(708) 783-2000
Fax
(708) 783-3656
NPI assigned
Jul 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-088397 IL Primary

Addresses

Primary practice location

3231 Euclid Ave FL 5
Berwyn, IL 60402-4603

Mailing address

3231 Euclid Ave FL 5
Berwyn, IL 60402-4603
Phone (087) 783-2000

Other identifiers 1

IdentifierTypeStateIssuer
036088397MedicaidIL

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
I20080108000871 IL Practitioner - Family Practice 0840370417 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Virginia School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Loyola Medical Group LLCGroup PAC ID 6305109547, 124 clinicians

Practice addresses (Care Compare)

3231 Euclid Ave
Suite 202
Berwyn, IL 60402-3472
Phone (708) 783-2700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-088397ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola Medical Group LLC CurrentSince Apr 9, 2018 Accepting new patients
Loyola University Medical Center Current Accepting new patients
Gottlieb Community Health Services Corporation CurrentSince Apr 9, 2018 Accepting new patients
Gottlieb Community Health Services Corporation CurrentSince Apr 9, 2018 Accepting new patients
Loyola University Medical Center Past Accepting new patients

Locations

3231 Euclid Ave
Ste 407
Berwyn, IL 60402
Phone (708) 783-7430

3231 Euclid Ave
Ste 202
Berwyn, IL 60402
Phone (708) 783-2700

3340 Oak Park Ave
Berwyn, IL 60402
Phone (312) 243-4244

3231 Euclid Ave
Fl 5
Berwyn, IL 60402
Phone (708) 783-2000

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

125 N La Grange Rd
La Grange, IL 60525
Phone (708) 354-4900

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

3722 Harlem Ave
Ste 202
Riverside, IL 60546
Phone (708) 783-0602

3722 Harlem Ave
Ste 101
Riverside, IL 60546
Phone (708) 783-6500

3722 Harlem Ave
Ste LL34
Riverside, IL 60546
Phone (708) 783-6566

Interoperability endpoints

  • Direct secure messaging: bralston104854@direct.luhs.org

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1710917109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 EUCLID AVE FL 5",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604024603",
            "telephone_number": "087-783-2000",
            "fax_number": "708-783-3656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 EUCLID AVE FL 5",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604024603",
            "telephone_number": "708-783-2000",
            "fax_number": "708-783-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RALSTON",
        "first_name": "BRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-088397",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036088397",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

Verify at the official NPI Registry.