Active NPI
Aida Ibricevic Richardson, M.D.
- Pediatric Pathology Physician
- Chicago, IL
National Provider Identifier
1871937060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Pathology Physician
- License
- 036149365
- Practice address
- 225 E Chicago Ave
Chicago, IL 60611-2991 - Phone
- (312) 227-4000
- Fax
- (312) 227-9409
- NPI assigned
- Apr 18, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Pathology Physician | 207ZP0213X | 036149365 | IL | Primary |
Addresses
Primary practice location
225 E Chicago Ave
Chicago, IL 60611-2991
Mailing address
225 E Chicago Ave
Chicago, IL 60611-2991
Phone (312) 227-4000
Other practice location 1
2515 N Clark St
Chicago, IL 60614-2730
Phone (800) 543-7362
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200409000247 | IL | Practitioner - Pathology | 7618273558 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036149365 | IL | MD | Pediatric Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lurie Children's Medical Group Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565308800000",
"number": "1871937060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 E CHICAGO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112991",
"telephone_number": "312-227-4000",
"fax_number": "312-227-9409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 E CHICAGO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112991",
"telephone_number": "312-227-4000",
"fax_number": "312-227-9409"
}
],
"practiceLocations": [
{
"address_1": "2515 N Clark St",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606142730",
"country_code": "US",
"telephone_number": "800-543-7362",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RICHARDSON",
"first_name": "AIDA",
"middle_name": "IBRICEVIC",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-18",
"last_updated": "2019-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207ZP0213X",
"taxonomy_group": "",
"desc": "Pathology, Pediatric Pathology",
"state": "IL",
"license": "036149365",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.