Individual provider Active NPI

Mangala Yeturu, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1912010125
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-081841 Issued in IL
Practice address
1357 W 103Rd St
Chicago, IL 60643-2392
Phone
(773) 238-0800
Fax
(773) 238-2710
NPI assigned
Aug 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-081841 IL Primary

Addresses

Primary practice location

1357 W 103Rd St
Chicago, IL 60643-2392

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address myeturu206422@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20040407000896 IL Practitioner - Internal MedicinePractitioner - Infectious Disease 9830084813 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 1978
Medicare assignment
May accept Medicare assignment
Group practices
Aamg Reach PLLCGroup PAC ID 5597133264, 52 clinicians

Practice addresses (Care Compare)

1357 W 103Rd St
Chicago, IL 60643-2392
Phone (773) 295-3101

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-081841ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health & Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Aamg Reach PLLC Internal Medicine CurrentSince Nov 20, 2022 Accepting new patients
Evergreen Care Center LTD PastSince Jan 17, 2012 Accepting new patients
Southwest Infectious Disease & Internal Medicine S C Infectious Disease PastSince Feb 12, 2002 Accepting new patients
John V. Kelly MD, PC Internal Medicine Past Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

4901 W 79th St
Ste 5
Burbank, IL 60459
Phone (708) 952-4403

1945 W Wilson Ave
Fl 4
Chicago, IL 60640
Phone (773) 736-6220

29373 Network Pl
Chicago, IL 60673

2545 S Ml King Dr
Chicago, IL 60616
Phone (312) 842-7117

1357 W 103rd St
Chicago, IL 60643
Phone (773) 238-0800

Interoperability endpoints

  • Direct secure messaging: myeturu206422@direct.myadvocateaurora.org

Organizations & group practices 7

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 5

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": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1912010125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 W 103RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606432392",
            "telephone_number": "773-238-0800",
            "fax_number": "773-238-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YETURU",
        "first_name": "MANGALA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-081841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "myeturu206422@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1357 W 103rd St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606432392",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1357 W 103rd St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606432392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.