Individual provider Active NPI

Vitaliy Y. Poylin, M.D.

  • Colon & Rectal Surgery Physician
  • Chicago, IL
National Provider Identifier
1942291604
Registry record updated Jun 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
03149083 Issued in IL
Practice address
259 E Erie St FL 16
Chicago, IL 60611-2987
Phone
(312) 695-6868
Fax
(312) 695-2729
NPI assigned
Nov 2, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X 225056 MA
Colon & Rectal Surgery Physician 208C00000X 03149083 IL Primary

Addresses

Primary practice location

259 E Erie St FL 16
Chicago, IL 60611-2987

Mailing address

259 E Erie St FL 16
Chicago, IL 60611-2987
Phone (312) 695-6868

Other practice location 1

330 Brookline Ave
Stoneman 9
Boston, MA 02215-5400
Phone (617) 667-4159

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100811000716 MA Practitioner - General SurgeryPractitioner - Colorectal Surgery (Proctology) 5597899617 Reassigns benefits to 1 organization
I20190617001396 IL Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 5597899617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)Also: General Surgery
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

250 E Superior
2304 Nwmff Prent WMN Hosp
Chicago, IL 60611-2914
Phone (312) 472-3660

250 E Superior St
Chicago, IL 60611-2914

251 E Huron
Chicago, IL 60611-2908

251 E Huron St
Chicago, IL 60611-2908

259 E Erie St
Chicago, IL 60611-2930
Phone (312) 503-1944

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy26
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03149083ILMDColon & Rectal Surgery Physician
225056MAMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2019 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Jul 1, 2010 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Colon & Rectal Surgery CurrentSince Jul 1, 2010 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2019 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

259 E Erie St
Fl 16
Chicago, IL 60611
Phone (312) 629-2620

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

225 E Chicago Ave
#118
Chicago, IL 60611

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

330 Brookline Ave
#9
Boston, MA 02215
Phone (617) 667-2100

Organizations & group practices 4

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 8

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1942291604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST FL 16",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112987",
            "telephone_number": "312-695-6868",
            "fax_number": "312-695-2729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST FL 16",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112987",
            "telephone_number": "312-695-6868",
            "fax_number": "312-695-2729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 Brookline Ave",
            "address_2": "Stoneman 9",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "022155400",
            "country_code": "US",
            "telephone_number": "617-667-4159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POYLIN",
        "first_name": "VITALIY",
        "middle_name": "Y.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MA",
            "license": "225056",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "IL",
            "license": "03149083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.