NPIMap

Individual provider Active NPI

Evan S Greenbaum, MD

  • Otolaryngology Physician
  • Chicago, IL
National Provider Identifier
1750511564
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
125056125 Issued in IL
Practice address
1900 W Polk St
Suite 465
Chicago, IL 60612-3723
Phone
(312) 864-5233
Fax
(312) 864-9638
NPI assigned
Jul 15, 2009
Last updated
Apr 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 125056125 IL Primary

Addresses

Primary practice location

1900 W Polk St
Suite 465
Chicago, IL 60612-3723

Mailing address

1900 W Polk St
Suite 465
Chicago, IL 60612-3723
Phone (312) 864-5233

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address egreenbaum@direct.ccprovider.org Direct Cook County

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151103001984 IL Practitioner - Otolaryngology 2961629605 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Loyola University of Chicago, Stritch School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook CountyGroup PAC ID 2860398088, 770 clinicians
Resilience Healthcare - Lakefront Medical Associates LLCGroup PAC ID 5991046468, 37 clinicians

Practice addresses (Care Compare)

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292

3 Eire CT
Oak Park, IL 60302-2519
Phone (708) 763-2328

500 E 51St St
Chicago, IL 60615-2494
Phone (312) 572-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125056125ILMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Resilience Healthcare - Lakefront Medical Associates, LLC CurrentSince Mar 1, 2022 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Oct 1, 2017 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Oct 1, 2017 Accepting new patients
Cook County Current Accepting new patients
Cook County CurrentSince Sep 30, 2015 Accepting new patients
Cook County CurrentSince Sep 30, 2015 Accepting new patients
John H. Stroger, Jr. Hospital of Cook County Past Accepting new patients
John H. Stroger, Jr. Hospital of Cook County Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

1900 W Polk St
Ste 465
Chicago, IL 60612
Phone (312) 864-0342

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

1969 W Ogden Ave
Chicago, IL 60612
Phone (312) 864-3600

4646 N Marine Dr
Chicago, IL 60640
Phone (773) 564-5102

4646 N Marine Dr
Ste C6500
Chicago, IL 60640
Phone (773) 728-4655

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

3 Erie Ct
Oak Park, IL 60302
Phone (708) 763-6200

Interoperability endpoints

  • Direct secure messaging: evan.greenbaum.1@18552.direct.athenahealth.com

Organizations & group practices 8

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 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1750511564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 W POLK ST",
            "address_2": "SUITE 465",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123723",
            "telephone_number": "312-864-5233",
            "fax_number": "312-864-9638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 W POLK ST",
            "address_2": "SUITE 465",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123723",
            "telephone_number": "312-864-5233",
            "fax_number": "312-864-9638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENBAUM",
        "first_name": "EVAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-15",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "125056125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "egreenbaum@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.