Individual provider Active NPI

Prentiss B Taylor, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1801055983
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-058964 Issued in IL
Practice address
9831 S Western Ave
Chicago, IL 60643-1740
Phone
(773) 445-3500
Fax
(773) 445-0575
NPI assigned
Jun 4, 2008
Last updated
Dec 16, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24029 MS
Internal Medicine Physician 207R00000X G86930 CA
Internal Medicine Physician 207R00000X 301696 LA
Internal Medicine Physician 207R00000X E-12633 AR
Internal Medicine Physician 207R00000X 51482 TN
Internal Medicine Physician 207R00000X 59992 MN
Internal Medicine Physician 207R00000X 01059715A IN
Internal Medicine Physician 207R00000X 37632 AZ
Internal Medicine Physician 207R00000X 28097 NE
Internal Medicine Physician 207R00000X 04-37501 KS
Internal Medicine Physician 207R00000X 9123410-1205 UT
Internal Medicine Physician 207R00000X MD-42030 IA
Internal Medicine Physician 207R00000X 2014029944 MO
Internal Medicine Physician 207R00000X Q3298 TX
Internal Medicine Physician 207R00000X 036-058964 IL Primary

Addresses

Primary practice location

9831 S Western Ave
Chicago, IL 60643-1740

Mailing address

29373 Network PL Ste 202
Chicago, IL 60673-1293
Phone (847) 390-5900

Other practice location 1

1357 W 103rd St
Chicago, IL 60643-2392
Phone (773) 238-0800

Other identifiers 1

IdentifierTypeStateIssuer
036058964OtherILLICENSE NUMBER

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ptaylor283954@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20080701000339 IL Practitioner - Internal Medicine 2567534829 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Harvard Medical School, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-12633ARMDInternal Medicine Physician
37632AZMDInternal Medicine Physician
G86930CAMDInternal Medicine Physician
MD-42030IAMDInternal Medicine Physician
036-058964ILMDInternal Medicine Physician
01059715AINMDInternal Medicine Physician
04-37501KSMDInternal Medicine Physician
301696LAMDInternal Medicine Physician
59992MNMDInternal Medicine Physician
2014029944MOMDInternal Medicine Physician
24029MSMDInternal Medicine Physician
28097NEMDInternal Medicine Physician
51482TNMDInternal Medicine Physician
Q3298TXMDInternal Medicine Physician
9123410-1205UTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health & Hospitals Corporation CurrentSince May 31, 2023 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

1357 W 103rd St
Chicago, IL 60643
Phone (773) 238-0800

2545 S Ml King Dr
Chicago, IL 60616
Phone (312) 842-7117

29373 Network Pl
Chicago, IL 60673

29373 Network Pl
Ste 202
Chicago, IL 60673

9831 S Western Ave
Chicago, IL 60643
Phone (773) 445-3500

Interoperability endpoints

  • Direct secure messaging: ptaylor283954@direct.myadvocateaurora.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1212537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1801055983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL STE 202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900",
            "fax_number": "847-390-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9831 S WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431740",
            "telephone_number": "773-445-3500",
            "fax_number": "773-445-0575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1357 W 103rd St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606432392",
            "country_code": "US",
            "telephone_number": "773-238-0800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "PRENTISS",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-04",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "24029",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G86930",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "301696",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-12633",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "51482",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "59992",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01059715A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "37632",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "28097",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "04-37501",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "9123410-1205",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "MD-42030",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2014029944",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "Q3298",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-058964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "036058964",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ptaylor283954@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9831 S Western Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606431740",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "9831 S Western Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606431740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.