Individual provider Active NPI

Madeline Carol Kwiatkowski, DO

  • Family Medicine Physician
  • St Charles, IL
National Provider Identifier
1245319979
Registry record updated Apr 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036071187 Issued in IL
Practice address
2900 Foxfield Rd
St Charles, IL 60174-5799
Phone
(630) 377-7900
Fax
(630) 377-8007
NPI assigned
Nov 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036071187 IL Primary
Family Medicine Physician 207Q00000X 5101009031 MI

Addresses

Primary practice location

2900 Foxfield Rd
St Charles, IL 60174-5799

Mailing address

2900 Foxfield Rd
St Charles, IL 60174-5799
Phone (630) 377-7900

Other identifiers 2

IdentifierTypeStateIssuer
920540033OtherILMEDICARE PTAN (INDIVIDUAL)
036071187MedicaidIL

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
I20111220000332 IL Practitioner - Family Practice 6305012402 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101009031MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Hospital Association CurrentSince Jun 29, 2000 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2021 Accepting new patients
Winfield Pathology Consultants, S.C. Current Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2021 Accepting new patients
Central Dupage Hospital Association CurrentSince Jun 29, 2000 Accepting new patients

Locations

820 S State Route 59
Ste A
Bartlett, IL 60103
Phone (630) 483-5930

Dept 5777
Carol Stream, IL 60122

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

2900 Foxfield Rd
St Charles, IL 60174
Phone (630) 377-6500

25 N Winfield Rd
Winfield, IL 60190
Phone (630) 682-1600

Organizations & group practices 5

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": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366588800000",
    "number": "1245319979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-377-7900",
            "fax_number": "630-377-8007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-377-7900",
            "fax_number": "630-377-8007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWIATKOWSKI",
        "first_name": "MADELINE",
        "middle_name": "CAROL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2013-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036071187",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101009031",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (INDIVIDUAL)",
            "identifier": "920540033",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036071187",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

Verify at the official NPI Registry.