Individual provider Active NPI

Charron McKenzie Lewis, M.D.

  • Developmental - Behavioral Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1831516962
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
036143391 Issued in IL
Practice address
5841 S Maryland Ave # Mc8016
Chicago, IL 60637
Phone
(773) 834-6822
Fax
(773) 702-0208
NPI assigned
Mar 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics Physician 2080P0006X 036143391 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave # Mc8016
Chicago, IL 60637

Mailing address

180 Harvester Dr Ste 110
Burr Ridge, IL 60527-6686
Phone (773) 702-1150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20200528001538 OH Practitioner - Pediatric Medicine 3779884598 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036143391ILMDDevelopmental - Behavioral Pediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System CurrentSince Jul 2, 2024 Accepting new patients
The Metrohealth System Current Accepting new patients
University Hospitals Medical Group Inc CurrentSince Jul 13, 2020 Accepting new patients
The Metrohealth System CurrentSince Jul 2, 2024 Accepting new patients

Locations

1299 Industrial Pkwy N
Fl 2
Brunswick, OH 44212
Phone (216) 957-1450

8055 Mayfield Rd
Ste 105
Chesterland, OH 44026
Phone (440) 214-8024

2500 Metrohealth Dr
Cleveland, OH 44109
Phone (216) 778-2348

2816 E 116th St
Cleveland, OH 44120
Phone (216) 696-3876

11100 Euclid Ave
Cleveland Heights, OH 44106

10 Severance Cir
Cleveland Heights, OH 44118
Phone (216) 297-2600

7800 Pearl Rd
Middleburg Heights, OH 44130
Phone (216) 778-4428

Interoperability endpoints

  • Direct secure messaging: clewis36306@ehrdirect.uhhospitals.org
  • Direct secure messaging: clewis281200@direct.metrohealth.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1831516962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 HARVESTER DR STE 110",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276686",
            "telephone_number": "773-702-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE # MC8016",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60637",
            "telephone_number": "773-834-6822",
            "fax_number": "773-702-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "CHARRON",
        "middle_name": "MCKENZIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "IL",
            "license": "036143391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.