Tomasz Piotr Lis, MD
Individual provider Active NPI Family Medicine Physician · Chicago, IL
NPI 1003122151 · NPPES record last updated Jan 3, 2020
Key facts
- NPI
- 1003122151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01083261A (IN)
- Practice address
- 2233 W Division St
Chicago, IL 60622-8151 - Phone
- (312) 770-2000
- NPI assigned
- Aug 26, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 48
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Crawford Hospital District
Genesis Health System
Practice addresses (Care Compare)
1000 N Allen St
Robinson, IL 62454-1114
Phone (618) 546-5600
1118 11TH St
De Witt, IA 52742-1353
Phone (563) 242-7522
Hospital & facility affiliations
- Northwest Health - Starke
- Jackson County Regional Health Center
- Crawford Memorial Hospital
- Mercyone Genesis Dewitt Medical Center
- Ripon Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in MN, IN, IL, IA, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131108000055 | MN | Practitioner - Family Practice | 8325273832 | Reassigns benefits to 8 organizations |
| I20200806003163 | IN | Practitioner - Emergency Medicine | 8325273832 | Reassigns benefits to 2 organizations |
| I20200909000994 | IL | Practitioner - Family Practice | 8325273832 | Reassigns benefits to 4 organizations |
| I20220302001593 | IA | Practitioner - Emergency Medicine | 8325273832 | Reassigns benefits to 5 organizations |
| I20240503003322 | WI | Practitioner - Emergency Medicine | 8325273832 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01083261A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Region Healthcare Corporation | Current |
Accepting new patients | |
| Crawford Hospital District | Current |
Accepting new patients | |
| Avera Marshall | Current |
Accepting new patients | |
| Sanford Health Network | Emergency Medicine | Current | Accepting new patients |
| Crawford Hospital District | Current |
Accepting new patients | |
| Emergency Professionals of Indiana, P.C. | Emergency Medicine | Current |
Accepting new patients |
| Sanford Health Network | Current | Accepting new patients | |
| Jackson County Public Hospital | Current | Accepting new patients | |
| Hendricks Community Hospital Assn & Retirement Home | Current |
Accepting new patients | |
| Genesis Health System | Current |
Accepting new patients | |
| Jackson County Public Hospital | Current |
Accepting new patients | |
| Jackson County Public Hospital | Current |
Accepting new patients | |
| Lake Region Healthcare Corporation | Current |
Accepting new patients | |
| Range Regional Health Services | Current |
Accepting new patients | |
| Agnesian Healthcare Inc | Family Medicine | Current |
Accepting new patients |
| Sanford Health Network | Family Medicine | Current |
Accepting new patients |
| Sanford Health Network | Current |
Accepting new patients | |
| Agnesian Healthcare Inc | Current |
Accepting new patients | |
| Agnesian Healthcare, Inc | Current | Accepting new patients | |
| Sanburg Emergency Group, P.C. | Emergency Medicine | Current |
Accepting new patients |
| North Indiana Emergency Physicians, LLP | Emergency Medicine | Current |
Accepting new patients |
| Statera Health Care, LLC | Emergency Medicine | Current |
Accepting new patients |
| Range Regional Health Services | Current |
Accepting new patients | |
| Crawford Hospital District | Family Medicine | Current | Accepting new patients |
| Hendricks Community Hospital Assn & Retirement Home | Current |
Accepting new patients | |
| County of Meeker | Current |
Accepting new patients | |
| Jackson County Public Hospital | Current | Accepting new patients | |
| Avera Marshall | Current | Accepting new patients | |
| County of Meeker | Current |
Accepting new patients | |
| Avera Marshall | Current |
Accepting new patients |
Locations (25 of 28)
1227 E Rusholme St
Davenport, IA 52803
Phone (563) 324-8160
1118 11th St
De Witt, IA 52742
Phone (563) 242-7522
601 Hospital Dr
Maquoketa, IA 52060
Phone (563) 652-2474
2250 N Illinois Ave
Carbondale, IL 62901
Phone (618) 833-1691
695 N Kellogg St
Galesburg, IL 61401
Phone (309) 343-8131
611 S Marshall Ave
Mc Leansboro, IL 62859
Phone (618) 542-2146
1000 N Allen St
Robinson, IL 62454
Phone (618) 544-3131
200 E Fairman Ave
Watseka, IL 60970
Phone (815) 432-5201
3700 Washington Ave
Evansville, IN 47714
Phone (812) 232-0021
102 E Culver Rd
Knox, IN 46534
Phone (574) 772-1580
1007 Lincolnway
Laporte, IN 46350
Phone (219) 325-5474
712 S Cascade St
Fergus Falls, MN 56537
750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441
612 S Sibley Ave
Litchfield, MN 55355
Phone (320) 693-3242
1601 Sioux Valley Dr
Luverne, MN 56156
Phone (507) 283-4476
1600 N Kniss Ave
Luverne, MN 56156
Phone (507) 283-2321
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
824 N 11th St
Montevideo, MN 56265
Phone (320) 269-8877
402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858
2150 Hospital Dr
Windom, MN 56101
Phone (507) 831-0618
1680 Diagonal Rd
Worthington, MN 56187
Phone (507) 372-3800
1018 6th Ave
Worthington, MN 56187
Phone (507) 343-6100
420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400
430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200
1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/d97362bf-37fe-407d-8a05-be96ba9615b1/
- tlis482453@direct.centracare.com
- https://api.platform.athenahealth.com/15486/brand/2/csg/1/fhir/r4
- https://fhir-myrecord.cerner.com/r4/Hq9lMFKIau9MlCiBN698ZPzTKNvsMrCb/
- https://api.platform.athenahealth.com/16494/brand/1/csg/1/fhir/r4
- tomasz.lis@avera.sdhealthlink.net
- https://fhir-myrecord.cerner.com/r4/e35355ac-dfca-48b9-9dd9-0b7c408c2a66/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 01083261A | IN | |
| Family Medicine Physician | 207Q00000X | 01083261A | IN | Yes |
Addresses
Primary practice location
2233 W Division St
Chicago, IL 60622-8151
Mailing address
501 E. Lincoln St.
PO Box 106
Hendricks, MN 56136
Phone (507) 275-3121
Other practice location 1
102 E Culver Rd
Knox, IN 46534-2216
Phone (574) 772-6231
Other providers in Chicago, IL
- Sorel Lira
- Carolyn Lis
- Daniel Theodore Lis Jr.
- Eric C Lis
- Paulina Marzena Lis
- Lisa a Rone MD
- Lisa a. Stanton, P.C.
- Lisa Catania, PC
- Lisa Demos LCPC and Associates, LLC
- Lisa Greising
All providers in Chicago, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.