Individual provider Active NPI

Thomas F. Gutchewsky, APN, CNP

  • Nurse Practitioner
  • Palos Heights, IL
National Provider Identifier
1013918598
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209002478 Issued in IL
Practice address
12251 S 80TH Ave Ste 1520
Palos Heights, IL 60463-1290
Phone
(708) 923-4200
Fax
(708) 923-4201
NPI assigned
Aug 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 209.002478 IL
Nurse Practitioner 363L00000X 209002478 IL Primary

Addresses

Primary practice location

12251 S 80TH Ave Ste 1520
Palos Heights, IL 60463-1290

Mailing address

12251 S 80TH Ave Ste 1520
Palos Heights, IL 60463-1290
Phone (708) 923-4200

Other identifiers 1

IdentifierTypeStateIssuer
F400287719OtherILMEDICARE PTAN

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041026000664 IL Practitioner - Nurse Practitioner 5496716011 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209002478ILMDNurse Practitioner
209.002478ILMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Sep 1, 2021 Accepting new patients
Central Dupage Physician Group CurrentSince Sep 1, 2021 Accepting new patients
Midwest Cardiovascular Institute SC CurrentSince Feb 6, 2023 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

133 E Brush Hill Rd
Ste 202
Elmhurst, IL 60126
Phone (331) 231-6200

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

801 S Washington St
Fl 4
Naperville, IL 60540
Phone (630) 416-8500

15300 West Ave
Orland Park, IL 60462
Phone (708) 226-2440

12251 S 80th Ave
Palos Heights, IL 60463
Phone (708) 361-4500

12251 S 80th Ave
Ste 1576
Palos Heights, IL 60463
Phone (708) 823-5300

12251 S 80th Ave
Ste 1520
Palos Heights, IL 60463
Phone (708) 923-3936

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 4

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1013918598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE STE 1520",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631290",
            "telephone_number": "708-923-4200",
            "fax_number": "708-923-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE STE 1520",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631290",
            "telephone_number": "708-923-4200",
            "fax_number": "708-923-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTCHEWSKY",
        "first_name": "THOMAS",
        "middle_name": "F.",
        "credential": "APN, CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "209.002478",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209002478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "F400287719",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

Verify at the official NPI Registry.