Individual provider Active NPI

Angelo G Tsakopoulos, M.D.

  • Family Medicine Physician
  • Tinley Park, IL
National Provider Identifier
1356320774
Registry record updated Oct 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-111440 Issued in IL
Practice address
17148 Harlem Ave
Tinley Park, IL 60477-3331
Phone
(708) 429-1200
NPI assigned
Jan 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2018

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 036-111440 IL Primary

Addresses

Primary practice location

17148 Harlem Ave
Tinley Park, IL 60477-3331

Mailing address

1860 Paysphere Cir
Chicago, IL 60674-4119
Phone (630) 469-2000

Other identifiers 1

IdentifierTypeStateIssuer
036111440MedicaidIL

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
I20050104000954 IL Practitioner - Family Practice 2567410756 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dupage Medical Group LTDGroup PAC ID 5496667941, 1,326 clinicians

Practice addresses (Care Compare)

17148 Harlem Ave
Tinley Park, IL 60477-3331
Phone (708) 429-1200

Hospital & facility affiliations

  • Ingalls Memorial Hospital Hospital, Harvey, IL, CCN 140191
  • Franciscan Health Olympia & Chicago Heights Hospital, Olympia Fields, IL, CCN 140172
  • Advocate Christ Hospital & Medical Center Hospital, Oak Lawn, IL, CCN 140208
  • Community Hospital Hospital, Munster, IN, CCN 150125

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-111440ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dupage Medical Group LTD CurrentSince Nov 1, 2018 Accepting new patients
Dupage Medical Group LTD CurrentSince Nov 1, 2018 Accepting new patients
West Suburban Medical Center Family Medicine Past Accepting new patients
West Suburban Hospital Medical Center Past Accepting new patients

Locations

30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210

1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000

17148 Harlem Ave
Tinley Park, IL 60477
Phone (708) 385-6100

Interoperability endpoints

  • Direct secure messaging: atsakopoulos184666@dulyhealthandcare.direct-ci.com

Organizations & group practices 4

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 5

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": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540771200000",
    "number": "1356320774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PAYSPHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606744119",
            "telephone_number": "630-469-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17148 HARLEM AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604773331",
            "telephone_number": "708-429-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSAKOPOULOS",
        "first_name": "ANGELO",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2018-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-111440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111440",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

Verify at the official NPI Registry.