NPIMap

Organization Active NPI

Aleksandr Dekhtyar MD SC

  • Psychiatry Physician
  • Deerfield, IL
National Provider Identifier
1801091582
Registry record updated Oct 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036110249 Issued in IL
Legal business name
ALEKSANDR DEKHTYAR MD SC
Practice address
614 Martin LN
Deerfield, IL 60015-3633
Phone
(224) 805-6085
NPI assigned
Jun 20, 2007
Last updated
Oct 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2008

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

Authorized official

Name
Aleksandr Dekhtyar, MDNPI 1851391155
Title
Provider
Phone
(224) 805-6085

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036110249 IL Primary

Addresses

Primary practice location

614 Martin LN
Deerfield, IL 60015-3633

Mailing address

614 Martin LN
Deerfield, IL 60015-3633
Phone (224) 805-6085

Other identifiers 1

IdentifierTypeStateIssuer
036110249MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070727000746 IL Part B Supplier - Clinic/Group Practice 6406957919 Receives reassigned benefits from 13 practitioners
Practice locations: Hoffman Estates, IL

National Provider Directory

National Provider Directory

Locations

2500 W Higgins Rd
Ste 210
Hoffman Estates, IL 60169
Phone (224) 489-3888

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1801091582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 MARTIN LN",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600153633",
            "telephone_number": "224-805-6085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 MARTIN LN",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600153633",
            "telephone_number": "224-805-6085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEKSANDR DEKHTYAR MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "DEKHTYAR",
        "authorized_official_first_name": "ALEKSANDR",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "224-805-6085",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036110249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110249",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deerfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; 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.