Individual provider Active NPI

Tegan Augustine Thimesch I, DPM

  • Foot Surgery Podiatrist
  • Chicago, IL
National Provider Identifier
1376511287
Registry record updated Feb 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
016003998 Issued in IL
Practice address
4040 W Peterson Ave
Chicago, IL 60646-6019
Phone
(773) 267-0554
Fax
(773) 267-6258
NPI assigned
Mar 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X 016003998 IL Primary

Addresses

Primary practice location

4040 W Peterson Ave
Chicago, IL 60646-6019

Mailing address

4040 W Peterson Ave
Chicago, IL 60646-6019
Phone (773) 267-0554

Other identifiers 1

IdentifierTypeStateIssuer
60001565OtherILBCBS

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
I20090603000679 IL Practitioner - PodiatryPractitioner - Sports Medicine 2961552476 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
PodiatryAlso: Sports Medicine
Education
William M. Scholl College of Podiatric Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

214 Washington St
Suite 3
Ingleside, IL 60041-9208
Phone (847) 587-3221

4040 W Peterson Ave
Chicago, IL 60646-6019
Phone (773) 267-0554

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue472
Removal of skin lesions27
Removal of nail tissue679
Removal or shaving of skin growth15
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016003998ILMDFoot Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Lake Foot Care LTD CurrentSince Jan 1, 1989 Accepting new patients
Dr Tegan a Timesh Footcare Clinic P.C. Foot Surgery CurrentSince Jan 1, 1989 Accepting new patients
SNZ Diagnostics Inc Past Accepting new patients

Locations

4040 W Peterson Ave
Chicago, IL 60646
Phone (773) 267-0554

4040 W Peterson Ave
Ste 3
Chicago, IL 60646

7505 Grand Ave
Gurnee, IL 60031
Phone (847) 245-8448

5101 Washington St
Gurnee, IL 60031
Phone (847) 802-8992

214 Washington St
Ste 3
Ingleside, IL 60041
Phone (847) 587-3015

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361836800000",
    "number": "1376511287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466019",
            "telephone_number": "773-267-0554",
            "fax_number": "773-267-6258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466019",
            "telephone_number": "773-267-0554",
            "fax_number": "773-267-6258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIMESCH",
        "first_name": "TEGAN",
        "middle_name": "AUGUSTINE",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2013-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "IL",
            "license": "016003998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "60001565",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.