Heidi Christine Memmel Mitidiero, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036107710 Issued in IL

Practice address

1000 N Westmoreland Rd
Lake Forest, IL 60045-1658

Phone

(847) 582-2134

Fax

(847) 535-7285

NPI assigned

May 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Heidi C Memmel Former name

Electronic endpoints 2

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

Specialty

General SurgeryAlso: Surgical Oncology

Education

Northwestern University Feinberg Medical School, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
• Advocate Lutheran General Hospital Hospital, Park Ridge, IL, CCN 140223

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hmemmel205107@direct.myadvocateaurora.org

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.

• Northwestern Medical Faculty Foundation

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Northwestern Medical Faculty Foundation

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• Central Dupage Physician Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844
  NPD (past)
• Windber Hospital, Inc.

  • General Acute Care Hospital
  • Windber, PA
  • NPI 1275620536
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Advocate Health and Hospitals Corporation

  • General Acute Care Hospital
  • Park Ridge, IL
  • NPI 1164539730
  Care Compare affiliation
• Northwestern Lake Forest Hospital

  • General Acute Care Hospital
  • Lake Forest, IL
  • NPI 1124025176
  Care Compare affiliation

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1184679193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N WESTMORELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451658",
            "telephone_number": "847-582-2134",
            "fax_number": "847-535-7285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N WESTMORELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451658",
            "telephone_number": "847-582-2134",
            "fax_number": "847-535-7285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 Luther Ln",
            "address_2": "Caldwell Breast Center",
            "address_purpose": "LOCATION",
            "city": "Park Ridge",
            "state": "IL",
            "postal_code": "600681270",
            "country_code": "US",
            "telephone_number": "847-723-3100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2701 Patriot Blvd",
            "address_purpose": "LOCATION",
            "city": "Glenview",
            "state": "IL",
            "postal_code": "600268039",
            "country_code": "US",
            "telephone_number": "847-582-2134",
            "fax_number": "847-535-7285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEMMEL MITIDIERO",
        "first_name": "HEIDI",
        "middle_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "36107710",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036107710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1700 Luther Ln",
            "address_2": "Caldwell Breast Center",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681270",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hmemmel205107@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1700 Luther Ln",
            "address_2": "Caldwell Breast Center",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HEIDI",
            "last_name": "MEMMEL",
            "middle_name": "C",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mebe Illinois
• Sharon Lynn Meekma, MS OTR/L
• Leslie Ann Mei, PA-C
• Melissa Carava, LLC
• Laura Ann Meller, MS, APN, CNS-BC
• Stacey Basilio Mendez, CRNA
• Scott Alan Metrick, M.D.
• Eric E Meyer, MD
• Gayle Lynn Meyer, RDH, OMT
• Jean F Meyer, CCC-SLP

• Surgery Physician in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; 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.