Individual provider Active NPI

Oleh R Terleckyj, MD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1144247958
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0360795Z1 Issued in IL
Practice address
2740 W Foster Ave
Ste LL7
Chicago, IL 60625
Phone
(773) 878-8200
Fax
(773) 293-4197
NPI assigned
Jul 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0360795Z1 IL Primary

Addresses

Primary practice location

2740 W Foster Ave
Ste LL7
Chicago, IL 60625

Mailing address

2740 W Foster Ave
Ste LL7
Chicago, IL 60625
Phone (773) 878-8200

Other identifiers 1

IdentifierTypeStateIssuer
0360795Z1MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address oterleckyj277031@direct.northshore.org

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
I20050414000721 IL Practitioner - Internal Medicine 5294772836 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0360795Z1ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Feb 20, 2023 Accepting new patients
Endeavor Health Medical Group Internal Medicine CurrentSince Feb 20, 2023 Accepting new patients

Locations

2740 W Foster Ave
Ste LL7
Chicago, IL 60625

5140 N California Ave
Ste 780
Chicago, IL 60625
Phone (773) 784-5140

5140 N California Ave
#405
Chicago, IL 60625
Phone (773) 275-5558

5140 N California Ave
Ste 405
Chicago, IL 60625
Phone (773) 275-5558

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

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": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1144247958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 W FOSTER AVE",
            "address_2": "STE LL7",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60625",
            "telephone_number": "773-878-8200",
            "fax_number": "773-293-4197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 W FOSTER AVE",
            "address_2": "STE LL7",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60625",
            "telephone_number": "773-878-8200",
            "fax_number": "773-293-4197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERLECKYJ",
        "first_name": "OLEH",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "0360795Z1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360795Z1",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oterleckyj277031@direct.northshore.org",
            "affiliation": "N",
            "address_1": "2740 W Foster Ave",
            "address_2": "Ste LL7",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.