Individual provider Active NPI

Edgar Rios, M.D

  • Urology Physician
  • Chicago, IL
National Provider Identifier
1962588608
Registry record updated Dec 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
036048072 Issued in IL
Practice address
4152 W 26TH St
Chicago, IL 60623-4312
Phone
(773) 521-1100
Fax
(773) 521-9032
NPI assigned
Oct 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology Physician 2088P0231X 036048072 IL
Urology Physician 208800000X 036048072 IL Primary

Addresses

Primary practice location

4152 W 26TH St
Chicago, IL 60623-4312

Mailing address

203 Midwest Club Pkwy
Oak Brook, IL 60523-2508
Phone (773) 521-1100

Other identifiers 2

IdentifierTypeStateIssuer
036048072MedicaidIL
0021608440OtherILBC/BS PROVIDER NUMBER

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
I20080312000034 IL Practitioner - Urology 4688759830

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036048072ILMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Shockwave Services, LTD. Urology CurrentSince Jun 21, 2013 Accepting new patients
United Shockwave Services, LTD. CurrentSince Jun 21, 2013 Accepting new patients

Locations

6701 159th St
Tinley Park, IL 60477
Phone (708) 429-0222

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513296000000",
    "number": "1962588608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 MIDWEST CLUB PKWY",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605232508",
            "telephone_number": "773-521-1100",
            "fax_number": "773-521-9032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4152 W 26TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234312",
            "telephone_number": "773-521-1100",
            "fax_number": "773-521-9032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIOS",
        "first_name": "EDGAR",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2017-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "IL",
            "license": "036048072",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036048072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036048072",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER NUMBER",
            "identifier": "0021608440",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.