Individual provider Active NPI

Iryna Serembytsky, M.D.

  • Family Medicine Physician
  • Riverside, IL
National Provider Identifier
1134415979
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036136127 Issued in IL
Practice address
366 E Burlington St
Riverside, IL 60546-2152
Phone
(708) 442-7174
NPI assigned
Jun 20, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 125.059087 IL
Family Medicine Physician 207Q00000X 036136127 IL Primary

Addresses

Primary practice location

366 E Burlington St
Riverside, IL 60546-2152

Mailing address

366 E Burlington St
Riverside, IL 60546-2152
Phone (708) 442-7174

Other practice location 1

2233 W Division St
Chicago, IL 60622-8151
Phone (312) 770-2000

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
I20140927000319 IL Practitioner - Family Practice 6305066226 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

366 E Burlington St
Suite 202
Riverside, IL 60546-2152
Phone (708) 442-7174

Hospital & facility affiliations

  • Loyola Medicine Home Care Home health agency, Oak Brook, IL, CCN 147257
  • Macneal Hospital Hospital, Berwyn, IL, CCN 140054
  • Loyola University Medical Center Hospital, Maywood, IL, CCN 140276
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Uchicago Medicine Adventhealth la Grange Hospital, La Grange, IL, CCN 140065

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.059087ILMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Westeros Family Practice, LTD Family Medicine CurrentSince Sep 15, 2016 Accepting new patients

Locations

21200 S Lagrange Rd
Frankfort, IL 60423
Phone (815) 406-5011

366 E Burlington St
Riverside, IL 60546
Phone (708) 442-7174

366 E Burlington St
Ste 202
Riverside, IL 60546
Phone (708) 442-7174

Organizations & group practices 1

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 8

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": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1134415979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 E BURLINGTON ST",
            "city": "RIVERSIDE",
            "state": "IL",
            "postal_code": "605462152",
            "telephone_number": "708-442-7174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366 E BURLINGTON ST",
            "city": "RIVERSIDE",
            "state": "IL",
            "postal_code": "605462152",
            "telephone_number": "708-442-7174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2233 W Division St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606228151",
            "country_code": "US",
            "telephone_number": "312-770-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEREMBYTSKY",
        "first_name": "IRYNA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-20",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125.059087",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036136127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, IL

Sources for this page

Verify at the official NPI Registry.