Tina M. Brueschke, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

36115136 Issued in IL

Practice address

2363 63Rd St
Woodridge, IL 60517-1369

Phone

(630) 716-7510

NPI assigned

Aug 19, 2006

Sex

Female

Sole proprietor

No

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.

• Valley Healthcare Associates, S.C

  • Internal Medicine Physician
  • Elburn, IL
  • NPI 1073603122
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 11, 2021.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1417062829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2363 63RD ST",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171369",
            "telephone_number": "630-716-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2363 63RD ST",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171369",
            "telephone_number": "630-716-7510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUESCHKE",
        "first_name": "TINA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36115136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tina.brueschke.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "2363 63rd St",
            "city": "Woodridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605171369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lakisha Britton, LSW
• Broad Chiropractic & Wellness PLLC
• Matthew Leon Broad, DC
• Abiodun Brown
• Lydia S Bruce, MD
• Monica Michelle Bullock, LCPC
• Bunco P.C.
• Emily Bunescu, LSW
• John Edward Buntrock, D.C.
• Robin Burek

• All providers in Woodridge, IL
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.