Individual provider Active NPI

Peter J. Feczko, M.D.

  • Diagnostic Radiology Physician
  • Detroit, MI
National Provider Identifier
1033287776
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
4301041301 Issued in MI
Practice address
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone
(313) 916-2600
Fax
(313) 916-3235
NPI assigned
Dec 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036055112 IL
General Practice Physician 208D00000X 4301041301 MI
Diagnostic Radiology Physician 2085R0202X 4301041301 MI Primary

Addresses

Primary practice location

2799 W Grand Blvd
Detroit, MI 48202-2608

Mailing address

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Other practice location 1

2650 Ridge Ave.
NorthShore Medical Group
Evanston, IL 60201
Phone (847) 570-2486

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230712000329 IL Practitioner - Diagnostic Radiology 2961537808 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Loyola University of Chicago, Stritch School of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

1000 E Rollins Rd
Round Lake Beach, IL 60073-2228
Phone (224) 364-2273

1162 W Maple Ave
Mundelein, IL 60060-1438
Phone (847) 367-2400

1300 Oak Ave
Evanston, IL 60201-4205
Phone (847) 869-1300

1329 N Wolf Rd
Mount Prospect, IL 60056-1500
Phone (847) 803-3040

1535 Ellinwood Ave
Des Plaines, IL 60016-4553
Phone (224) 364-2273

2100 Pfingsten Rd
Glenview, IL 60026-1301

2650 Ridge Ave
Evanston, IL 60201-1700

3122 N Ashland Ave
Chicago, IL 60657-3014
Phone (773) 687-0999

3304 W Touhy Ave
Skokie, IL 60076-7200
Phone (224) 364-2273

501 Skokie Blvd
Northbrook, IL 60062-2802
Phone (847) 504-2300

524 Main St
Evanston, IL 60202-1815
Phone (224) 364-2273

6450 W Touhy Ave
Niles, IL 60714-4512

680 N Lake Shore Dr
Suite 924
Chicago, IL 60611-8701
Phone (312) 664-6848

71 Waukegan Rd
Suite 700
Lake Bluff, IL 60044-1614
Phone (224) 364-2273

777 Park Ave W
Highland Park, IL 60035-2433

7900 Rollins Rd
Gurnee, IL 60031-1512

920 Milwaukee Ave
Lincolnshire, IL 60069-3839
Phone (847) 866-7846

9600 Gross Point Rd
Skokie, IL 60076-1214

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Jul 1, 2023 Accepting new patients
Endeavor Health Medical Group CurrentSince Jul 1, 2023 Accepting new patients
Lehigh Valley Diagnostic Imaging Past Accepting new patients
Medical Imaging of Lehigh Valley PC Diagnostic Radiology Past Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

Interoperability endpoints

  • Direct secure messaging: pfeczko12646@direct.hfhs.org

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1033287776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-2600",
            "fax_number": "313-916-3235"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2650 Ridge Ave.",
            "address_2": "NorthShore Medical Group",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "60201",
            "country_code": "US",
            "telephone_number": "847-570-2486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FECZKO",
        "first_name": "PETER",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2023-07-07",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036055112",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301041301",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301041301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.