Individual provider Active NPI

Pratik Mehta, MD

  • Emergency Medicine Physician
  • Chicago, IL
National Provider Identifier
1841425824
Registry record updated May 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
125-056050 Issued in IL
Practice address
7435 W Talcott Ave
Resurrection Emergency Medicine Residency Program
Chicago, IL 60631-3707
Phone
(773) 792-7921
NPI assigned
May 20, 2009
Last updated
May 20, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 125-056050 IL Primary

Addresses

Primary practice location

7435 W Talcott Ave
Resurrection Emergency Medicine Residency Program
Chicago, IL 60631-3707

Mailing address

7435 W Talcott Ave
Resurrection Emergency Medicine Residency Program
Chicago, IL 60631-3707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20120627000177 GA Practitioner - Emergency Medicine 3173784055 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical College of Wisconsin, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gwinnett Emergency Specialists, LLCGroup PAC ID 0840373619, 50 clinicians
Gwinnett Emergency Specialists Observation Services LLCGroup PAC ID 7618140955, 38 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125-056050ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Emergency Associates, LLC Emergency Medicine CurrentSince Mar 20, 2020 Accepting new patients
Gwinnett Emergency Specialists, LLC Emergency Medicine CurrentSince Aug 1, 2012 Accepting new patients
Gwinnett Emergency Specialists Observation Services, LLC Emergency Medicine CurrentSince Aug 1, 2012 Accepting new patients
Lafayette Emergency Care, P.C. Emergency Medicine Past Accepting new patients

Locations

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1242777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242777600000",
    "number": "1841425824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7435 W TALCOTT AVE",
            "address_2": "RESURRECTION EMERGENCY MEDICINE RESIDENCY PROGRAM",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7435 W TALCOTT AVE",
            "address_2": "RESURRECTION EMERGENCY MEDICINE RESIDENCY PROGRAM",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313707",
            "telephone_number": "773-792-7921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "PRATIK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-20",
        "last_updated": "2009-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125-056050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.