Elissa Kim Adatya, M.D.
Individual provider Active NPI Internal Medicine Physician · Downers Grove, IL
NPI 1871784553 · NPPES record last updated Jan 11, 2022
Key facts
- NPI
- 1871784553
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 036136928 (IL)
- Practice address
- 1333 Butterfield Rd
Ste 130
Downers Grove, IL 60515-5607 - Phone
- (630) 371-0133
- Fax
- (630) 371-0138
- NPI assigned
- Aug 7, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180523000312 | CA | Practitioner - Internal Medicine | 0345425807 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 246976 | NY | MD | Internal Medicine Physician |
| 048846 | CT | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Permanente Medical Group, Inc | Current |
Accepting new patients | |
| Permanente Medical Group Inc | Internal Medicine | Current |
Accepting new patients |
| Permanente Medical Group Inc | Internal Medicine | Current | Accepting new patients |
Locations
750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131
4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738
900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014
1800 Harrison St
Fl 7
Oakland, CA 94612
101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109
1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015
901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500
930 W Main St
Ripon, CA 95366
Phone (209) 599-4221
2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000
75 N 13th St
San Jose, CA 95112
Phone (408) 295-2665
700 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 851-5300
710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400
5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700
7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000
975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000
320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834
Interoperability endpoints
- elissa.adatya.1@19661.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036136928 | IL | Yes |
| Internal Medicine Physician | 207R00000X | 55534 | MN | |
| Hospitalist Physician | 208M00000X | 048846 | CT | |
| Internal Medicine Physician | 207R00000X | 048846 | CT | |
| Internal Medicine Physician | 207R00000X | 246976 | NY |
Addresses
Primary practice location
1333 Butterfield Rd
Ste 130
Downers Grove, IL 60515-5607
Mailing address
1333 Butterfield Rd
Ste 130
Downers Grove, IL 60515-5607
Phone (630) 371-0133
Other names
- Elissa D Kim
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Other providers in Downers Grove, IL
- Aarlan Vincent Aceto
- Kavitha Achanta
- Ache and Awe Therapy, PLLC
- Jessica Acuna
- Dakota Adamec
- Addus Healthcare, Inc.
- Oluyemi Samson Adeagbo
- Kristine Marie Adrowski
- Advanced Headache and Neurocare Clinic
- Advanced Heart Lipid Clinic
All providers in Downers Grove, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.