Individual provider Active NPI

Max John Pitlosh, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1760454904
Registry record updated Sep 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036107071 Issued in IL
Practice address
2835 N Sheffield Ave
Suite 104
Chicago, IL 60657-5081
Phone
(773) 472-3704
NPI assigned
Feb 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2011

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 036107071 IL Primary

Addresses

Primary practice location

2835 N Sheffield Ave
Suite 104
Chicago, IL 60657-5081

Mailing address

2835 N Sheffield Ave
Suite 104
Chicago, IL 60657-5081
Phone (773) 472-3704

Other identifiers 1

IdentifierTypeStateIssuer
036107071MedicaidIL

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
I20061201000347 IL Practitioner - Family Practice 6608874565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

1700 W Van Buren St
Chicago, IL 60612-5500
Phone (312) 563-2875

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036107071ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Center CurrentSince Apr 1, 2020 Accepting new patients
Rush University Medical Group Family Medicine CurrentSince Apr 1, 2020 Accepting new patients

Locations

1725 W Harrison St
Ste 10
Chicago, IL 60612
Phone (312) 563-3700

75 Remittance Dr
Dept 1611
Chicago, IL 60675

2835 N Sheffield Ave
Ste 104
Chicago, IL 60657
Phone (312) 876-4577

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

Interoperability endpoints

  • Direct secure messaging: mpitlosh19968@direct.rush.rush-health.com

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": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316563200000",
    "number": "1760454904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2835 N SHEFFIELD AVE",
            "address_2": "SUITE 104",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575081",
            "telephone_number": "773-472-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 N SHEFFIELD AVE",
            "address_2": "SUITE 104",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575081",
            "telephone_number": "773-472-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITLOSH",
        "first_name": "MAX",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2011-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036107071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036107071",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.