Individual provider Active NPI

Mohan Gundeti

  • Pediatric Urology Physician
  • Chicago, IL
National Provider Identifier
1790968147
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
036140700 Issued in IL
Practice address
5841 S Maryland Ave
Chicago, IL 60637-1443
Phone
(888) 824-0200
NPI assigned
Dec 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology Physician 2088P0231X 036140700 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave
Chicago, IL 60637-1443

Mailing address

150 Harvester Dr
Suite 300
Burr Ridge, IL 60527-5919

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgundetimd21826@uchospital.direct-ci.com University of Chicago Physicians Group

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
I20080216000028 IL Practitioner - Urology 4587747324 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians
The University of Chicago Medical CenterGroup PAC ID 7618880766, 907 clinicians

Practice addresses (Care Compare)

5758 S Maryland Ave
Chicago, IL 60637-1426
Phone (773) 702-3384

5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (773) 702-1000

950 E 61St St
RM 207
Chicago, IL 60637-2654
Phone (773) 702-3095

Hospital & facility affiliations

  • The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036140700ILMDPediatric Urology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Chicago Medical Center CurrentSince May 15, 2013 Accepting new patients
Shriners Hospitals for Children CurrentSince Sep 14, 2022 Accepting new patients
The University of Chicago Medical Center CurrentSince May 15, 2013 Accepting new patients
University of Chicago CurrentSince Nov 23, 2010 Accepting new patients
Shriners Hospitals for Children Current Accepting new patients
Shriners Hospitals for Children CurrentSince Sep 14, 2022 Accepting new patients
Shriners Hospitals for Children Past Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

2211 N Oak Park Ave
Chicago, IL 60707
Phone (773) 385-5463

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Organizations & group practices 7

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 1

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": "1196985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1790968147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HARVESTER DR",
            "address_2": "SUITE 300",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "888-824-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDETI",
        "first_name": "MOHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-07",
        "last_updated": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "IL",
            "license": "036140700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgundetimd21826@uchospital.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "University of Chicago Physicians Group",
            "address_1": "5841 S Maryland Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606371443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.