Individual provider Active NPI

Ashley Czworniak, DO

  • Pediatric Critical Care Medicine Physician
  • Park Ridge, IL
National Provider Identifier
1043700305
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
036.170827 Issued in IL
Practice address
1775 Dempster St
Park Ridge, IL 60068-1143
Phone
(847) 723-0122
Fax
(847) 723-9687
NPI assigned
May 12, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 036.170827 IL Primary

Addresses

Primary practice location

1775 Dempster St
Park Ridge, IL 60068-1143

Mailing address

4832 N Nordica Ave
Chicago, IL 60656-3821
Phone (773) 415-6676

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20211221000066 TX Practitioner - Pediatric Medicine 9830580190 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.170827ILMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tuba City Regional Health Care Corporation Family Medicine Current Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Sep 27, 2021 Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Sep 27, 2021 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1526083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1043700305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4832 N NORDICA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606563821",
            "telephone_number": "773-415-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 DEMPSTER ST",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681143",
            "telephone_number": "847-723-0122",
            "fax_number": "847-723-9687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CZWORNIAK",
        "first_name": "ASHLEY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-12",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "IL",
            "license": "036.170827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.