NPIMap

Individual provider Active NPI

Shirley Lee Termolen, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1952369563
Registry record updated Mar 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036096045 Issued in IL
Practice address
200 S Michigan Ave
Suite 805
Chicago, IL 60604-2402
Phone
(312) 922-3815
Fax
(312) 922-7449
NPI assigned
May 3, 2006
Last updated
Mar 4, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2011

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 036096045 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 2

IdentifierTypeStateIssuer
0360960451MedicaidIL
363762672OtherILTAX ID FOR PRACTICE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110314000852 IL Practitioner - Internal Medicine 7416969910 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Ohio State University College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

200 S Michigan Ave
Suite 1400
Chicago, IL 60604-2426
Phone (312) 922-1290

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036096045ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ami P Desai MD SC Internal Medicine Current Accepting new patients
Angelo a Costas MD SC Internal Medicine Current Accepting new patients
David a Vermylen MD SC Internal Medicine Current Accepting new patients
Michigan Avenue Internists Internal Medicine CurrentSince Jul 1, 1998 Accepting new patients
Shirley Lee Termolen MD SC Internal Medicine CurrentSince Apr 28, 2019 Accepting new patients

Locations

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

200 S Michigan Ave
Ste 1400
Chicago, IL 60604
Phone (312) 922-3815

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299196800000",
    "number": "1952369563",
    "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": "312-922-7449"
        },
        {
            "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": "312-922-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERMOLEN",
        "first_name": "SHIRLEY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-03",
        "last_updated": "2011-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036096045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360960451",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID FOR PRACTICE",
            "identifier": "363762672",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.