Individual provider Active NPI

Ravi Mishra, M.B.B.S.

  • Neonatal-Perinatal Medicine Physician
  • Chicago, IL
National Provider Identifier
1841238276
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
036-112466 Issued in IL
Practice address
836 W Wellington Ave
Chicago, IL 60657-5147
Phone
(773) 296-5435
NPI assigned
Jun 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 036-112466 IL Primary

Addresses

Primary practice location

836 W Wellington Ave
Chicago, IL 60657-5147

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
036-112466MedicaidIL
214881OtherILMEDICARE GROUP ID

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rmishra242506@direct.myadvocateaurora.org
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
I20041208001190 IL Practitioner - Pediatric Medicine 6204892466 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-112466ILMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Sep 16, 2019 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Sep 16, 2019 Accepting new patients
Chicago Gastro LLC Past Accepting new patients
Boston Children'S Health Physicians, LLP Neonatal-Perinatal Medicine Past Accepting new patients
Midwest Neoped Associates LTD PastSince Jun 28, 2009 Accepting new patients

Locations

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

75 Remittance Dr
Dept 1611
Chicago, IL 60675

836 W Wellington Ave
Chicago, IL 60657
Phone (773) 296-7054

29373 Network Pl
Chicago, IL 60673

Interoperability endpoints

  • Direct secure messaging: rmishra242506@direct.myadvocateaurora.org
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

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": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1841238276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 W WELLINGTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575147",
            "telephone_number": "773-296-5435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISHRA",
        "first_name": "RAVI",
        "credential": "M.B.B.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-04",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036-112466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-112466",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "214881",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rmishra242506@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "836 W Wellington Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606575147",
            "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": "836 W Wellington Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606575147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.