NPIMap

Individual provider Active NPI

Demetrios Petrovas, MD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1871547505
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
36084958 Issued in IL
Practice address
3960 N. Harlem Ave.
Chicago, IL 60634
Phone
(773) 658-2300
Fax
(773) 658-2305
NPI assigned
May 19, 2006
Last updated
Jan 20, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

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 36084958 IL Primary
Internal Medicine Physician 207R00000X A50087 CA

Addresses

Primary practice location

3960 N. Harlem Ave.
Chicago, IL 60634

Mailing address

3960 N Harlem Ave
Chicago, IL 60634-2267
Phone (773) 658-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090107000055 IL Practitioner - Internal Medicine 7012070725 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3960 N Harlem Ave
Chicago, IL 60634-2267
Phone (773) 658-2300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A50087CAMDInternal Medicine Physician
36084958ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Demetrios Petrovas M.D. S.C. CurrentSince Feb 1, 1996 Accepting new patients

Locations

3960 N Harlem Ave
Chicago, IL 60634
Phone (773) 589-2400

5962 N Lincoln Ave
Ste 12
Chicago, IL 60659
Phone (773) 989-0585

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 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421712000000",
    "number": "1871547505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3960 N HARLEM AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606342267",
            "telephone_number": "773-658-2300",
            "fax_number": "773-658-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 N. HARLEM AVE.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60634",
            "telephone_number": "773-658-2300",
            "fax_number": "773-658-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROVAS",
        "first_name": "DEMETRIOS",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2015-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "36084958",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A50087",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.