Active NPI
Brojendra Agarwala, M.D.
- Pediatric Cardiology Physician
- Chicago, IL
National Provider Identifier
1780668285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 036046668
- Practice address
- 5841 S Maryland Ave
MC 4051
Chicago, IL 60637-1447 - Phone
- (773) 795-4475
- Fax
- (773) 702-2319
- NPI assigned
- Nov 30, 2005
- 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 |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 036046668 | IL | Primary |
Addresses
Primary practice location
5841 S Maryland Ave
MC 4051
Chicago, IL 60637-1447
Mailing address
5841 S Maryland Ave
MC 4051
Chicago, IL 60637-1447
Phone (773) 795-4475
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01621679 | Other | IL | BCBS OF IL |
| 036046668 | Medicaid | IL |
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 |
|---|---|---|---|
| 036046668 | IL | MD | Pediatric Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edward Cardiovascular Institute | Past | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Interoperability endpoints
- bagarwalamd21641@uchospital.direct-ci.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.
-
- Cardiovascular Disease Physician
- Naperville, IL
- NPI 1649386400
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363219200000",
"number": "1780668285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5841 S MARYLAND AVE",
"address_2": "MC 4051",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371447",
"telephone_number": "773-795-4475",
"fax_number": "773-702-2319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5841 S MARYLAND AVE",
"address_2": "MC 4051",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371447",
"telephone_number": "773-795-4475",
"fax_number": "773-702-2319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGARWALA",
"first_name": "BROJENDRA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-30",
"last_updated": "2013-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "IL",
"license": "036046668",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF IL",
"identifier": "01621679",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036046668",
"state": "IL"
}
],
"endpoints": [],
"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 Mar 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.