Individual provider Active NPI

Necholas Ghannam, MD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1962480541
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036112505 Issued in IL
Practice address
9831 S Western Ave
Chicago, IL 60643-1740
Phone
(773) 445-3500
Fax
(773) 445-1931
NPI assigned
Jan 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036112505 IL Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 036112505 IL

Addresses

Primary practice location

9831 S Western Ave
Chicago, IL 60643-1740

Mailing address

29373 Network PL
Chicago, IL 60673-1293

Other identifiers 1

IdentifierTypeStateIssuer
036112505MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address nghannam206249@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
I20041130000065 IL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 4082679238 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Aamg Reach PLLCGroup PAC ID 5597133264, 52 clinicians
Advocate Health and Hospitals CorporationGroup PAC ID 7810800935, 3,081 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

  • Advocate Home Health Care Serv Home health agency, Oakbrook, IL, CCN 147150
  • Advocate Christ Hospital & Medical Center Hospital, Oak Lawn, IL, CCN 140208
  • Advocate Trinity Hospital Hospital, Chicago, IL, CCN 140048

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aamg Reach PLLC Internal Medicine CurrentSince Nov 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients

Locations

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

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

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

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

9831 S Western Ave
Chicago, IL 60643
Phone (773) 445-3500

29373 Network Pl
Chicago, IL 60673

Interoperability endpoints

  • Direct secure messaging: nghannam206249@direct.myadvocateaurora.org

Organizations & group practices 3

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": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1962480541",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9831 S WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431740",
            "telephone_number": "773-445-3500",
            "fax_number": "773-445-1931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANNAM",
        "first_name": "NECHOLAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036112505",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036112505",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112505",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nghannam206249@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9831 S Western Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606431740",
            "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": "9831 S Western Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606431740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.