The Board of Trustees of the University of Illinois

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Practice address

820 S Wood St
Chicago, IL 60612-4325

Phone

(312) 996-2779

NPI assigned

Apr 25, 2007

Last updated

May 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kailas Sanghani

Title

Director of Finance

Phone

(312) 413-1350

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dept of Urology Other name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• The Board of Trustees of the University of Illinois

  dba UIC Physician Group

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1134118649

  O20031201000484

  Same enrollment

Locations

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Omer Acar, MD

  • Urology Physician
  • Chicago, IL
  • NPI 1376037010
  NPD
• Lori A Cornelius, NP-C

  • Family Nurse Practitioner
  • Bradley, IL
  • NPI 1275906828
  NPD
• Simone Crivellaro, MD

  • Urology Physician
  • Chicago, IL
  • NPI 1730382201
  NPD
• Keitha Davis, APRN, FNP-BC, FPA

  • Nurse Practitioner
  • Chicago, IL
  • NPI 1922516723
  NPD
• Daniel Garvey, MD

  • Urology Physician
  • Elk Grove Village, IL
  • NPI 1467400390
  NPD
• Emilie Johnson, MD

  • Pediatric Urology Physician
  • Chicago, IL
  • NPI 1366568784
  NPD
• Ervin Kocjancic, MD

  • Urology Physician
  • Chicago, IL
  • NPI 1841423878
  NPD
• Dennis B Liu, M.D.

  • Urology Physician
  • Chicago, IL
  • NPI 1124076724
  NPD
• Ikenna Madueke, M.D., PH.D.

  • Urology Physician
  • Chicago, IL
  • NPI 1366839581
  NPD
• Mahmoud Mima

  • Urology Physician
  • Chicago, IL
  • NPI 1629592639
  NPD
• Daniel Martins Moreira, M.D.

  • Urology Physician
  • Chicago, IL
  • NPI 1851559421
  NPD
• Craig S. Niederberger, M.D.

  • Urology Physician
  • Chicago, IL
  • NPI 1700991270
  NPD

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1760601892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7732 SOLUTION CENTER",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606770001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S WOOD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124325",
            "telephone_number": "312-996-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "SANGHANI",
        "authorized_official_first_name": "KAILAS",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "312-413-1350"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "01619048",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD GROUP",
            "identifier": "CG6661",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dept of Urology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Dept of Urology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• The Board of Trustees of the University of Illinois
• The Board of Trustees of the University of Illinois
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• The Board of Trustees of the University of Illinois (UI Health Mile Square Health Center Dental - 55th & Pulaski)
• The Board of Trustees of the University of Illinois (University of Illinois Medical Center at Chicago)
• The Board of Trustees of the University of Illinois (UIC DHD Family Clinic)
• The Board of Trustees of the University of Illinois (University of Illinois Oncology Pharmacy)
• The Board of Trustees of the University of Illinois (Integrated Health Care - AVIVA)

• Urology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Urology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.