Individual provider Active NPI

Shakthi D Kumar, MD

  • Gastroenterology Physician
  • Elmhurst, IL
National Provider Identifier
1881853596
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036130435 Issued in IL
Practice address
133 E Brush Hill Rd Ste 310
Elmhurst, IL 60126-5662
Phone
(331) 221-9003
Fax
(331) 221-2743
NPI assigned
Jun 6, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 036130435 IL Primary

Addresses

Primary practice location

133 E Brush Hill Rd Ste 310
Elmhurst, IL 60126-5662

Mailing address

4201 Winfield Rd FL 4
Warrenville, IL 60555-4025
Phone (331) 221-6377

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dkumar49061@direct.edward.org Direct

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
I20150723008485 IL Practitioner - Gastroenterology 1759694409 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Michigan State University College of Human Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

1200 S York Rd
Suite 1120
Elmhurst, IL 60126-5626
Phone (630) 527-3200

1200 S York St
Elmhurst, IL 60126-5626
Phone (331) 221-6636

155 E Brush Hill Rd
Elmhurst, IL 60126-5658
Phone (331) 221-0096

177 E Brush Hill Rd
Elmhurst, IL 60126-5658
Phone (630) 646-6020

2650 Ridge Ave
Evanston, IL 60201-1700

Hospital & facility affiliations

  • Elmhurst Memorial Hospital Hospital, Elmhurst, IL, CCN 140200
  • Edward Hospital Hospital, Naperville, IL, CCN 140231

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy43
Upper gastrointestinal (GI) endoscopy for acid reflux73

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036130435ILMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Elmhurst Memorial Healthcare CurrentSince Aug 15, 2015 Accepting new patients
Endeavor Health Medical Group CurrentSince Jun 22, 2021 Accepting new patients
Elmhurst Memorial Healthcare CurrentSince Aug 15, 2015 Accepting new patients
Endeavor Health Medical Group CurrentSince Jan 1, 2024 Accepting new patients
Wyse Eyecare SC Past Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

1200 S York St
Ste 2000
Elmhurst, IL 60126
Phone (331) 221-9002

172 E Schiller St
Elmhurst, IL 60126
Phone (331) 221-6377

1200 S York St
Elmhurst, IL 60126
Phone (331) 221-5678

133 E Brush Hill Rd
Ste 310
Elmhurst, IL 60126
Phone (331) 221-9003

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

4201 Winfield Rd
Fl 4
Warrenville, IL 60555

Interoperability endpoints

  • Direct secure messaging: dkumar49061@direct.edward.org

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1881853596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 WINFIELD RD FL 4",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605554025",
            "telephone_number": "331-221-6377",
            "fax_number": "331-221-2357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 E BRUSH HILL RD STE 310",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601265662",
            "telephone_number": "331-221-9003",
            "fax_number": "331-221-2743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUMAR",
        "first_name": "SHAKTHI",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-06",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036130435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dkumar49061@direct.edward.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "133 E Brush Hill Rd Ste 310",
            "city": "Elmhurst",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601265662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elmhurst, IL

Sources for this page

Verify at the official NPI Registry.