Individual provider Active NPI

Dustin Ryan Fraidenburg, M.D.

  • Pulmonary Disease Physician
  • Chicago, IL
National Provider Identifier
1235365586
Registry record updated May 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
036.131110 Issued in IL
Practice address
1740 W Taylor St
Chicago, IL 60612-7232
Phone
(866) 600-2273
NPI assigned
Jun 1, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 036.131110 IL Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 036131110 IL

Addresses

Primary practice location

1740 W Taylor St
Chicago, IL 60612-7232

Mailing address

6138 Lakeview Park Dr
Linden, MI 48451-9098
Phone (810) 845-5969

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
I20160810001982 IL Practitioner - Critical Care (Intensivists)Practitioner - Pulmonary Disease 3173833423 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Pulmonary Disease
Education
Wayne State University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

840 S Wood St MC
787 Uic Medicine
Chicago, IL 60612-4325
Phone (312) 413-8687

Hospital & facility affiliations

  • University of Illinois Hospital and Clinics Hospital, Chicago, IL, CCN 140150

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.131110ILMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Jul 1, 2016 Accepting new patients
The Board of Trustees of the University of Illinois Critical Care Medicine CurrentSince Jul 1, 2016 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients

Locations

1740 W Taylor St
Ste 1400
Chicago, IL 60612
Phone (312) 996-3900

845 W Wilson Ave
Chicago, IL 60640
Phone (312) 744-1295

7732 Solutions Ctr
Chicago, IL 60677

1855 W Taylor St
Chicago, IL 60612
Phone (312) 996-6582

1740 W Taylor St
Chicago, IL 60612
Phone (312) 355-4000

840 S Wood St
#787
Chicago, IL 60612
Phone (312) 413-8687

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

Interoperability endpoints

  • Direct secure messaging: dustin.fraidenburg.1@3547.direct.athenahealth.com
  • Direct secure messaging: dfraidenburg17036@uihealth.direct-ci.com

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.

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": "1243814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525392000000",
    "number": "1235365586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6138 LAKEVIEW PARK DR",
            "city": "LINDEN",
            "state": "MI",
            "postal_code": "484519098",
            "telephone_number": "810-845-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127232",
            "telephone_number": "866-600-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAIDENBURG",
        "first_name": "DUSTIN",
        "middle_name": "RYAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-01",
        "last_updated": "2018-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036.131110",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IL",
            "license": "036131110",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.