Individual provider Active NPI

Pavan Kumar Srivastava, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1841404373
Registry record updated Apr 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036125749 Issued in IL
Practice address
1801 W Taylor St
Clinic 3Aa
Chicago, IL 60612-4795
Phone
(312) 413-3627
Fax
(312) 355-0212
NPI assigned
May 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036125749 IL Primary
Pediatrics Physician 208000000X 036125749 IL

Addresses

Primary practice location

1801 W Taylor St
Clinic 3Aa
Chicago, IL 60612-4795

Mailing address

840 S Wood St
MC 718
Chicago, IL 60612-4325

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
I20121119000223 IL Practitioner - Internal MedicinePractitioner - Pediatric Medicine 3870744915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1801 W Taylor St
3F
Chicago, IL 60612-4795
Phone (312) 355-4300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036125749ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Pediatrics CurrentSince Aug 1, 2012 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Aug 1, 2012 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Board of Trustees of the University of Illinois Internal Medicine Past Accepting new patients
The Board of Trustees of the University of Illinois Internal Medicine Past Accepting new patients

Locations

1801 W Taylor St
#3
Chicago, IL 60612
Phone (312) 413-3627

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-4210

840 S Wood St
#718
Chicago, IL 60612
Phone (224) 650-7123

1855 W Taylor St
Chicago, IL 60612
Phone (312) 996-6582

1801 W Taylor St
#3F
Chicago, IL 60612
Phone (312) 355-4300

840 S Wood St
#856
Chicago, IL 60612
Phone (312) 413-1429

7732 Solutions Ctr
Chicago, IL 60677

845 W Wilson Ave
Chicago, IL 60640
Phone (312) 744-1295

1801 W Taylor St
Chicago, IL 60612
Phone (312) 355-1700

Interoperability endpoints

  • Direct secure messaging: psrivastava17499@uihealth.direct-ci.com

Organizations & group practices 5

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 1

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": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366156800000",
    "number": "1841404373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 S WOOD ST",
            "address_2": "MC 718",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124325",
            "fax_number": "312-413-8283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W TAYLOR ST",
            "address_2": "CLINIC 3AA",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124795",
            "telephone_number": "312-413-3627",
            "fax_number": "312-355-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRIVASTAVA",
        "first_name": "PAVAN",
        "middle_name": "KUMAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2013-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036125749",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036125749",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.