Individual provider Active NPI

Shahrzad Fakhraee, MD

  • Neurology Physician
  • Bloomington, IL
National Provider Identifier
1841934270
Registry record updated Aug 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036181830 Issued in IL
Practice address
2200 E Washington St
Bloomington, IL 61701-4364
Phone
(309) 662-3311
NPI assigned
Apr 22, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 036181830 IL Primary

Addresses

Primary practice location

2200 E Washington St
Bloomington, IL 61701-4364

Mailing address

2200 E Washington St
Bloomington, IL 61701-4364
Phone (309) 662-3311

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://epicsoap.carle.com/FHIR/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
I20220810000190 IL Order and Referring Only - NeurologyPractitioner - Neurology 2264815166

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1-031-535-6ILMDNeurology Physician

Interoperability endpoints

  • Direct secure messaging: sfakhraeemd349812@carlehiedirect.net

NPI Registry JSON

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

{
    "created_epoch": "1650585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1841934270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E WASHINGTON ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014364",
            "telephone_number": "309-662-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E WASHINGTON ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014364",
            "telephone_number": "309-662-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAKHRAEE",
        "first_name": "SHAHRZAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-22",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036181830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://epicsoap.carle.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "urbana,il",
            "address_1": "611 W Park St",
            "city": "Urbana",
            "state": "IL",
            "country_code": "US",
            "postal_code": "618012529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.