One provider matched this Medicaid ID.
Illinois Medicaid ID 036104792 resolves to a single NPI record. Open the full profile for complete detail.
Secondary identifiers
Additional identifiers this provider has registered with NPPES. Used by medical billers, credentialers, and insurance verifiers to cross-reference claims and enrollments.
Other
- 036104792IL· Issued by STATE LICENSE NUMBER
- 110248524· Issued by RAILROAD MEDICARE
- 2159428· Issued by UNITED HEALTHCARE
- 300025539· Issued by TRICARE
- 01032021IL· Issued by BLUE CROSS BLUE SHIELD
- 610234· Issued by HEALTHLINK, INC.
- 7388481· Issued by AETNA
- 8553891001· Issued by CIGNA HEALTHCARE
Medicaid
Source: NPPES public registry.
Medicare enrollment
This provider holds a Medicare enrollment on file with the Provider Enrollment, Chain and Ownership System (PECOS). Each enrollment carries a public Medicare Enrollment ID (ENRLMT_ID) used by billers and intermediaries.
Practitioner
- I20080311000371Internal MedicineIL
Source: CMS PECOS public enrollment file.
ReferenceAbout state Medicaid identifiers
State Medicaid programmes assign each enrolled provider a state-scoped identifier used on Medicaid claims. The identifier is reported to the federal NPPES registry alongside the provider's NPI and is mirrored here from the public dissemination file. Each state administers its own Medicaid programme, so the same provider can hold different Medicaid numbers in different states.