Active NPI
Redouane Boumendjel, MD
- Anatomic Pathology & Clinical Pathology Physician
- Chicago, IL
National Provider Identifier
1730349028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 125051840
- Practice address
- 840 S Wood St
Suite 130 CSN
Chicago, IL 60612 - Phone
- (312) 996-7250
- NPI assigned
- Jun 11, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 125051840 | IL | Primary |
Addresses
Primary practice location
840 S Wood St
Suite 130 CSN
Chicago, IL 60612
Mailing address
1775 Dempster St
Park Ridge, IL 60068-1143
Phone (847) 723-5549
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rboumendjel237961@direct.myadvocateaurora.org | Direct |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pathology
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1775 Dempster St
Park Ridge, IL 60068-1143
Phone (847) 723-2210
Hospital & facility affiliations
- Advocate Lutheran General Hospital
- Advocate Good Shepherd Hospital
- Advocate Illinois Masonic Medical Center
- Advocate Condell Medical Center
- Advocate Christ Hospital & Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125051840 | IL | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Diagnostic Pathology SC | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
Locations
3815 Highland Ave
Downers Grove, IL 60515
Phone (630) 275-5900
520 E 22nd St
Lombard, IL 60148
Phone (630) 874-2542
1775 W Dempster St
Park Ridge, IL 60068
Phone (847) 723-5150
Organizations & group practices 1
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.
-
- Anatomic Pathology & Clinical Pathology Physician
- Park Ridge, IL
- NPI 1982606380
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Libertyville, IL
- NPI 1124272547
-
- Mobile Mammography Clinic/Center
- Grayslake, IL
- NPI 1770737199
Hospital
-
- General Acute Care Hospital
- Park Ridge, IL
- NPI 1164539730
-
- General Acute Care Hospital
- Barrington, IL
- NPI 1447368071
-
- Children's Hospital
- Oak Lawn, IL
- NPI 1508315516
-
- General Acute Care Hospital
- Oak Lawn, IL
- NPI 1548375082
-
- General Acute Care Hospital
- Chicago, IL
- NPI 1912014564
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639008000000",
"number": "1730349028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1775 DEMPSTER ST",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681143",
"telephone_number": "847-723-5549",
"fax_number": "847-723-7540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 S WOOD ST",
"address_2": "SUITE 130 CSN",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60612",
"telephone_number": "312-996-7250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUMENDJEL",
"first_name": "REDOUANE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-11",
"last_updated": "2021-12-09",
"certification_date": "2021-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "IL",
"license": "125051840",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rboumendjel237961@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1775 Dempster St",
"city": "Park Ridge",
"state": "IL",
"country_code": "US",
"postal_code": "600681143",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; 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.