Ian Zachary Lewis, D.O.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

036180691 Issued in IL

Practice address

420 NE Glen Oak Ave Ste 401
Peoria, IL 61603

Phone

(309) 676-8123

Fax

(309) 676-8455

NPI assigned

Jun 16, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

NephrologyAlso: Internal Medicine

Education

Michigan State University College of Osteopathic Medicine, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ilewis645052@direct.froedtert.com

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.

• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment NPD

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782864000000",
    "number": "1053937995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 E MONROE ST",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502356",
            "telephone_number": "734-301-8648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE STE 401",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61603",
            "telephone_number": "309-676-8123",
            "fax_number": "309-676-8455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "702 Rittenhouse",
            "address_purpose": "LOCATION",
            "city": "Pontiac",
            "state": "IL",
            "postal_code": "61764",
            "country_code": "US",
            "telephone_number": "309-676-8123",
            "fax_number": "309-676-8455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1302 Franklin Ave Ste 3000",
            "address_purpose": "LOCATION",
            "city": "Normal",
            "state": "IL",
            "postal_code": "61761",
            "country_code": "US",
            "telephone_number": "309-676-8123",
            "fax_number": "309-676-8455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "IAN",
        "middle_name": "ZACHARY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-16",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036180691",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036180691",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha A Leverton, APN
• Deidra K Lewandowski, N.P.
• Jordyn Lewandowski, APRN
• Catherine Lewellen, MSW
• Angella Maria Lewis, LCPC
• Mary Elizabeth Lewis, C-FNP
• Robert Leysaht, APN
• David Spancer Li
• Wenting Li, DO
• Yibing Li, MD

• Nephrology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Nephrology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.