SOUTHWEST NEPHROLOGY ASSOCIATES, S.C. – Ambulatory Surgical Clinic/Center, NPI 1104925163
Ambulatory Surgical Clinic/Center
Main info
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SOUTHWEST NEPHROLOGY ASSOCIATES, S.C.
9125 S Pulaski Rd
Evergreen Park, IL 608051441
Phone: (708) 422-7715
Fax: (708) 422-7816
Type: Location
120 W 22ND ST STE 200
OAK BROOK, IL 605231563
Phone: (630) 573-5000
Fax: (708) 422-7816
Type: Mailing
South Pulaski Road, Evergreen Park, Worth Township, Cook County, Illinois, 60805, United States
EVERGREEN PARK, IL 608051441
Phone: (708) 422-7715
Fax: (708) 422-7816
Type: Mailing
120 W 22ND ST
STE 200
OAK BROOK, IL 605231563
Phone: (630) 573-5000
Fax: (708) 422-7816
Type: Mailing
16605 107TH ST
ORLAND PARK, IL 604679016
Phone: (708) 226-9860
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-08-25
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-02-29 (828 days ago).
Enrollment records
1
Earliest due date
2024-02-29
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040825000464 | O | Clinic/Group Practice | IL | 2024-02-29 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60805)
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