Individual provider Active NPI

Charles George Mavros, MD

  • Student in an Organized Health Care Education/Training Program
  • Chicago, IL
National Provider Identifier
1891315016
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1740 W Taylor St
Chicago, IL 60612-7232
Phone
(866) 600-2273
NPI assigned
Apr 17, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X IL Primary

Addresses

Primary practice location

1740 W Taylor St
Chicago, IL 60612-7232

Mailing address

1740 W Taylor St RM 3200W
Chicago, IL 60612-7232
Phone (312) 996-4020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20240918004258 IN Practitioner - Anesthesiology 2264973155 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Indiana University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Anesthesia PCGroup PAC ID 1951322353, 28 clinicians

Practice addresses (Care Compare)

1500 S Lake Park Ave
Hobart, IN 46342-6638
Phone (219) 942-0551

Hospital & facility affiliations

  • St Mary Medical Center Inc Hospital, Hobart, IN, CCN 150034
  • Community Hospital Hospital, Munster, IN, CCN 150125
  • Powers Health Rehabilitation Center Inpatient rehabilitation facility, Crown Point, IN, CCN 153045

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Anesthesia, P.C. CurrentSince Jul 5, 2024 Accepting new patients
Loyola University Medical Center Current Accepting new patients

Locations

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

5776 Grape Rd
Ste 51
Mishawaka, IN 46545

Interoperability endpoints

  • Direct secure messaging: cmavros226317@direct.luhs.org
  • Direct secure messaging: cmavros69199@uihealth.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1891315016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST RM 3200W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127232",
            "telephone_number": "312-996-4020",
            "fax_number": "312-996-4019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127232",
            "telephone_number": "866-600-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVROS",
        "first_name": "CHARLES",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.