NPIMap

Organization Active NPI

Michigan Avenue Internists

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1922066588
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MICHIGAN AVENUE INTERNISTS
Practice address
200 S Michigan Ave
Suite 805
Chicago, IL 60604-2402
Phone
(312) 922-3815
Fax
(312) 922-3789
NPI assigned
May 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Dr. Greg Donald Ewert, M.D.
Title
President
Phone
(312) 922-3815

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X IL
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X IL Primary

Addresses

Primary practice location

200 S Michigan Ave
Suite 805
Chicago, IL 60604-2402

Mailing address

200 S Michigan Ave
Suite 805
Chicago, IL 60604-2402
Phone (312) 922-3815

Other identifiers 1

IdentifierTypeStateIssuer
01605414OtherILBC/BS OF ILLINOIS #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050615000205 IL Part B Supplier - Clinic/Group Practice 9537103163 Receives reassigned benefits from 13 practitioners
Practice locations: Chicago, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0694244Michigan Avenue Internists LLC200 South Michigan Suite #805, Chicago, IL 60604Certificate of waiverMar 21, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1922066588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S MICHIGAN AVE",
            "address_2": "SUITE 805",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606042402",
            "telephone_number": "312-922-3815",
            "fax_number": "312-922-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S MICHIGAN AVE",
            "address_2": "SUITE 805",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606042402",
            "telephone_number": "312-922-3815",
            "fax_number": "312-922-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN AVENUE INTERNISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "EWERT",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-922-3815",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF ILLINOIS #",
            "identifier": "01605414",
            "state": "IL"
        }
    ],
    "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 Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.