Individual provider Active NPI

Steven A Marciniak, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Aurora, IL
National Provider Identifier
1205813813
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
036097420 Issued in IL
Practice address
2111 Ogden Ave
Aurora, IL 60504-7597
Phone
(630) 978-3800
Fax
(630) 862-3085
NPI assigned
Dec 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 036097420 IL
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 036097420 IL Primary

Addresses

Primary practice location

2111 Ogden Ave
Aurora, IL 60504-7597

Mailing address

1256 Waterford Dr Ste 230
Aurora, IL 60504-4511
Phone (630) 499-2404

Other identifiers 1

IdentifierTypeStateIssuer
036097420MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036097420ILMDOrthopaedic Surgery Physician

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559088000000",
    "number": "1205813813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1256 WATERFORD DR STE 230",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044511",
            "telephone_number": "630-499-2404",
            "fax_number": "630-692-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 OGDEN AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047597",
            "telephone_number": "630-978-3800",
            "fax_number": "630-862-3085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCINIAK",
        "first_name": "STEVEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2019-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "036097420",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IL",
            "license": "036097420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036097420",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.