Active NPI
Ellen Fertelmeister, M.D.
- Internal Medicine Physician
- Skokie, IL
National Provider Identifier
1740343193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036-071978
- Practice address
- PMS 8170 MC Cormick Blvd
Suite 204
Skokie, IL 60076-2920 - Phone
- (847) 410-2029
- Fax
- (847) 410-2041
- NPI assigned
- Dec 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036-071978 | IL | Primary |
Addresses
Primary practice location
PMS 8170 MC Cormick Blvd
Suite 204
Skokie, IL 60076-2920
Mailing address
8170 MC Cormick Blvd
Suite 204
Skokie, IL 60076-2920
Phone (847) 410-2029
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036-071978 | Other | IL | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-071978 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Macneal Physicians Group LLC | Internal Medicine | Past | Accepting new patients |
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.
-
- Internal Medicine Physician
- Berwyn, IL
- NPI 1205024791
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740343193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8170 MC CORMICK BLVD",
"address_2": "SUITE 204",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600762920",
"telephone_number": "847-410-2029",
"fax_number": "847-410-2041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PMS 8170 MC CORMICK BLVD",
"address_2": "SUITE 204",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600762920",
"telephone_number": "847-410-2029",
"fax_number": "847-410-2041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERTELMEISTER",
"first_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036-071978",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "036-071978",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Skokie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.