Individual provider Active NPI

Shishir Jain, M.D.

  • Internal Medicine Physician
  • Cicero, IL
National Provider Identifier
1811085822
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
3698420 Issued in IL
Practice address
5909 W 35TH St
Cicero, IL 60804-4163
Phone
(708) 652-2040
Fax
(708) 652-0058
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 3698420 IL Primary

Addresses

Primary practice location

5909 W 35TH St
Cicero, IL 60804-4163

Mailing address

5909 W 35TH St
Cicero, IL 60804-4163
Phone (708) 652-2040

Other identifiers 6

IdentifierTypeStateIssuer
110202292OtherILRR MEDICARE PIN
667OtherILCHICAGO HEALTH SYSTEMS (CHS)
277392OtherILWELLCARE HMO
3698420OtherILSTATE LICENCE NO.
003698420OtherILBLUE SHEILD
036098420MedicaidIL

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
I20060413000515 IL Practitioner - Internal Medicine 9335158690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

235 Remington Blvd E
Bolingbrook, IL 60440-3685
Phone (630) 771-1201

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3698420ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
I.Desai & R.Gokani,M.D.,S.C. Internal Medicine CurrentSince Jul 1, 1999 Accepting new patients
I.Desai & R. Gokani, M.D.,S.C. Internal Medicine CurrentSince Jul 1, 1999 Accepting new patients

Locations

235 Remington Blvd
Bolingbrook, IL 60440

235 Remington Blvd
Ste E
Bolingbrook, IL 60440
Phone (630) 771-1201

5909 W 35th St
Cicero, IL 60804
Phone (708) 298-4802

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.

Hospital & facility affiliations 3

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": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213833600000",
    "number": "1811085822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5909 W 35TH ST",
            "city": "CICERO",
            "state": "IL",
            "postal_code": "608044163",
            "telephone_number": "708-652-2040",
            "fax_number": "708-652-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5909 W 35TH ST",
            "city": "CICERO",
            "state": "IL",
            "postal_code": "608044163",
            "telephone_number": "708-652-2040",
            "fax_number": "708-652-0058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "SHISHIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2008-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "3698420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "110202292",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHICAGO HEALTH SYSTEMS (CHS)",
            "identifier": "667",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE HMO",
            "identifier": "277392",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCE NO.",
            "identifier": "3698420",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHEILD",
            "identifier": "003698420",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036098420",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cicero, IL

Sources for this page

Verify at the official NPI Registry.