Individual provider Active NPI

Walter Liszewski, MD

  • Dermatology Physician
  • Chicago, IL
National Provider Identifier
1033505243
Registry record updated Jul 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036.149833 Issued in IL
Practice address
676 N Saint Clair St Ste 1600
Chicago, IL 60611-2997
Phone
(312) 695-8106
NPI assigned
Apr 14, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 62406 MN
Student in an Organized Health Care Education/Training Program 390200000X
Dermatology Physician 207N00000X 036.149833 IL Primary

Addresses

Primary practice location

676 N Saint Clair St Ste 1600
Chicago, IL 60611-2997

Mailing address

676 N Saint Clair St Ste 1600
Chicago, IL 60611-2997
Phone (312) 695-8106

Other practice location 1

7918 Sycamore St
New Orleans, LA 70118
Phone (504) 344-7620

Other practice location 2

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123

Other practice location 3

1021 Bandana Blvd E Ste 100
Saint Paul, MN 55108
Phone (612) 262-5000

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
I20190808001792 IL Practitioner - Dermatology 5496040958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Tulane University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

676 N St Clair
1600 Dept of Dermatology
Chicago, IL 60611-2997
Phone (312) 695-8106

Hospital & facility affiliations

  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

Merit-based Incentive Payment System (MIPS)

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions217
Removal or shaving of skin growth1-10
Skin biopsy94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28038MNMDLicensed Practical Nurse
036.149833ILMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2019 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2019 Accepting new patients
Central Dupage Physician Group PastSince Aug 6, 2019 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

676 N Saint Clair St
Ste 1600
Chicago, IL 60611
Phone (312) 695-8106

1630 Sherman Ave
Ste 200
Evanston, IL 60201
Phone (847) 534-3278

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Interoperability endpoints

  • Direct secure messaging: walter.liszewski.1@3547.direct.athenahealth.com

Organizations & group practices 3

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 3

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": "1428969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564358400000",
    "number": "1033505243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112997",
            "telephone_number": "312-695-8106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112997",
            "telephone_number": "312-695-8106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7918 Sycamore St",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "70118",
            "country_code": "US",
            "telephone_number": "504-344-7620",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3800 Park Nicollet Blvd",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554162527",
            "country_code": "US",
            "telephone_number": "952-993-3123",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1021 Bandana Blvd E Ste 100",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "55108",
            "country_code": "US",
            "telephone_number": "612-262-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LISZEWSKI",
        "first_name": "WALTER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-14",
        "last_updated": "2019-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "62406",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036.149833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.