Individual provider Active NPI

Edi Kapetanovic, MD/MBA

  • Diagnostic Radiology Physician
  • Chicago, IL
National Provider Identifier
1841796935
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036164007 Issued in IL
Practice address
676 N Saint Clair St Ste 800
Chicago, IL 60611-2978
Phone
(312) 695-5978
NPI assigned
Apr 5, 2018
Last updated
Nov 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036164007 IL Primary

Addresses

Primary practice location

676 N Saint Clair St Ste 800
Chicago, IL 60611-2978

Mailing address

676 N Saint Clair St Ste 800
Chicago, IL 60611-2978
Phone (312) 695-5978

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20240829003242 NY Practitioner - Diagnostic Radiology 8729315478 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Yale University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ellis HospitalGroup PAC ID 5890607410, 250 clinicians

Practice addresses (Care Compare)

1101 Nott St
Schenecctady, NY 12308-2425
Phone (518) 243-4000

315 S Manning Blvd
Albany, NY 12208-1707
Phone (518) 525-1852

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036164007ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ellis Hospital CurrentSince Aug 19, 2024 Accepting new patients
St. Peter's Health Partners Medical Associates, P.C. Diagnostic Radiology CurrentSince Aug 19, 2024 Accepting new patients

Locations

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

1101 Nott St
Schenectady, NY 12308
Phone (518) 243-1916

2 New Hampshire Ave
Troy, NY 12180
Phone (518) 272-0331

2215 Burdett Ave
Troy, NY 12180
Phone (518) 271-3300

1301 River St
Ste 204
Valatie, NY 12184
Phone (518) 392-8600

Interoperability endpoints

  • Direct secure messaging: ekapetanovic3493027@direct.trinity-health.org

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

Hospital & facility affiliations 9

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": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1841796935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 800",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112978",
            "telephone_number": "312-695-5978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 800",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112978",
            "telephone_number": "312-695-5978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAPETANOVIC",
        "first_name": "EDI",
        "credential": "MD/MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-05",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036164007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.