Individual provider Active NPI

Daniel R Kowalzyk, DO

  • Emergency Medicine Physician
  • Blue Island, IL
National Provider Identifier
1184647752
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Practice address
12935 S. Gregory St.
Blue Island, IL 60406
Phone
(708) 597-2000
Fax
(708) 824-4494
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X IL Primary

Addresses

Primary practice location

12935 S. Gregory St.
Blue Island, IL 60406

Mailing address

533 W North Ave
102
Elmhurst, IL 60126-2135
Phone (800) 732-1066

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
I20080115000709 IL Practitioner - Emergency Medicine 6305927450 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Harvey Emergency Physicians PLLCGroup PAC ID 9436486560, 50 clinicians

Practice addresses (Care Compare)

1 Ingalls Dr
Harvey, IL 60426-3558
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036081146ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harvey Emergency Physicians, PLLC Emergency Medicine CurrentSince Aug 27, 2019 Accepting new patients
Em Strategies,LTD. Emergency Medicine PastSince Jul 25, 2019 Accepting new patients
Illinois/Indiana Em-I Medical Services, S.C. Emergency Medicine Past Accepting new patients
Midwest Emergency Northern Illinois Inc Emergency Medicine Past Accepting new patients

Locations

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

Interoperability endpoints

  • Direct secure messaging: dkowalzykdo237204@uchospital.direct-ci.com

Organizations & group practices 4

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 1

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184647752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "533 W NORTH AVE",
            "address_2": "102",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601262135",
            "telephone_number": "800-732-1066",
            "fax_number": "630-941-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12935 S. GREGORY ST.",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "60406",
            "telephone_number": "708-597-2000",
            "fax_number": "708-824-4494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALZYK",
        "first_name": "DANIEL",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Island, IL

Sources for this page

Verify at the official NPI Registry.