MIDWEST INSTITUTE FOR MINIMALLY INVASIVE THERAPIES – Vascular & Interventional Radiology Physician, NPI 1578505947
Vascular & Interventional Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MIDWEST INSTITUTE FOR MINIMALLY INVASIVE THERAPIES
9730 S Western Ave # B01
Evergreen Park, IL 608052814
Phone: (708) 486-2600
Fax: (708) 486-2610
Type: Location
2415 S Michigan Ave
Chicago, IL 606162301
Phone: (708) 486-2600
Fax: (708) 486-2610
Type: Location
North Avenue, Melrose Park, Proviso Township, Cook County, Illinois, 60160, United States
SUITE 402
MELROSE PARK, IL 601601634
Phone: (708) 486-2600
Fax: (708) 486-2610
Type: Location
Triangle Plaza West, 8770, West Bryn Mawr Avenue, O'Hare, Chicago, Jefferson Township, Cook County, Illinois, 60631, United States
SUITE 1300
CHICAGO, IL 60631
Phone: (708) 486-2600
Fax: (708) 486-2610
Type: Mailing
1011 E TOUHY AVE STE 350
DES PLAINES, IL 600185829
Phone: (708) 486-2600
Fax: (708) 486-2610
Type: Mailing
12 SALT CREEK LN STE 105
HINSDALE, IL 605218607
Phone: (708) 486-2600
Fax: (708) 486-2610
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: 2004-10-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-09-30 (984 days ago).
Enrollment records
1
Earliest due date
2023-09-30
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 |
|---|---|---|---|---|
| O20041004000102 | O | Clinic/Group Practice | IL | 2023-09-30 |
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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