Active NPI
Alexander W Reardon, MD
- Addiction Medicine (Psychiatry & Neurology) Physician
- Dekalb, IL
National Provider Identifier
1407505175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Medicine (Psychiatry & Neurology) Physician
- License
- 036175181
- Practice address
- 1 Kish Hospital Dr
Dekalb, IL 60115-9602 - Phone
- (815) 766-7334
- Fax
- (815) 766-9768
- NPI assigned
- Mar 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | 036175181 | IL | Primary |
| Emergency Medicine Physician | 207P00000X | 036175181 | IL |
Addresses
Primary practice location
1 Kish Hospital Dr
Dekalb, IL 60115-9602
Mailing address
1 Kish Hospital Dr
Dekalb, IL 60115-9602
Phone (815) 766-7334
Other practice location 1
251 E Huron St
Chicago, IL 60611-3055
Phone (312) 926-2000
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220606002626 | IL | Order and Referring Only - Emergency Medicine | 5890173710 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.079294 | IL | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789603200000",
"number": "1407505175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 KISH HOSPITAL DR",
"city": "DEKALB",
"state": "IL",
"postal_code": "601159602",
"telephone_number": "815-766-7334",
"fax_number": "815-766-9768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KISH HOSPITAL DR",
"city": "DEKALB",
"state": "IL",
"postal_code": "601159602",
"telephone_number": "815-766-7334",
"fax_number": "815-766-9768"
}
],
"practiceLocations": [
{
"address_1": "251 E Huron St",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606113055",
"country_code": "US",
"telephone_number": "312-926-2000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REARDON",
"first_name": "ALEXANDER",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-21",
"last_updated": "2026-09-17",
"certification_date": "2026-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084A0401X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": "IL",
"license": "036175181",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IL",
"license": "036175181",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.