NPIMap

Individual provider Active NPI

Graziella I Bistriceanu, M.D.

  • Family Medicine Physician
  • West Dundee, IL
National Provider Identifier
1316911472
Registry record updated Jul 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036112686 Issued in IL
Practice address
1925 Huntley Rd
West Dundee, IL 60118-9301
Phone
(815) 338-6600
Fax
(847) 428-7425
NPI assigned
Feb 15, 2006
Last updated
Jul 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036112686 IL Primary

Addresses

Primary practice location

1925 Huntley Rd
West Dundee, IL 60118-9301

Mailing address

1925 Huntley Rd
West Dundee, IL 60118-9301
Phone (815) 338-6600

Other identifiers 1

IdentifierTypeStateIssuer
0361126861MedicaidIL

Other names 1

  • Graziella I Iacovenco Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050627000974 IL Practitioner - Family Practice 9638114986 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

3707 Doty Rd
Woodstock, IL 60098-7530

515 Valley View Dr
Suite 201
Moline, IL 61265-6175
Phone (312) 695-0870

650 Dakota St
Crystal Lake, IL 60012-3744
Phone (815) 338-6600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036112686ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group Family Medicine CurrentSince Jul 19, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2021 Accepting new patients
Mercy Health System Corporation CurrentSince Jun 4, 2008 Accepting new patients
Mercy Health System Corporation CurrentSince Jun 4, 2008 Accepting new patients
Central Dupage Physician Group CurrentSince Jul 19, 2021 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Medical Specialists LTD Family Medicine Past Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

348 S Division St
Harvard, IL 60033
Phone (815) 943-1122

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

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

1925 Huntley Rd
West Dundee, IL 60118
Phone (847) 854-3421

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

2000 Lake Ave
Woodstock, IL 60098
Phone (815) 337-4116

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1316911472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 HUNTLEY RD",
            "city": "WEST DUNDEE",
            "state": "IL",
            "postal_code": "601189301",
            "telephone_number": "815-338-6600",
            "fax_number": "847-428-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 HUNTLEY RD",
            "city": "WEST DUNDEE",
            "state": "IL",
            "postal_code": "601189301",
            "telephone_number": "815-338-6600",
            "fax_number": "847-428-7425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISTRICEANU",
        "first_name": "GRAZIELLA",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-15",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036112686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0361126861",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRAZIELLA",
            "last_name": "IACOVENCO",
            "middle_name": "I",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Dundee, IL

Sources for this page

Verify at the official NPI Registry.