Individual provider Active NPI

Mary R. Wyers, MD

  • Pediatric Radiology Physician
  • Chicago, IL
National Provider Identifier
1447244496
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Radiology PhysicianTaxonomy code 2085P0229X
License
036-105455 Issued in IL
Practice address
225 E Chicago Ave # 9
Chicago, IL 60611-2991
Phone
(312) 227-4500
Fax
(312) 227-9785
NPI assigned
Sep 6, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036-105455 IL
Pediatric Radiology Physician 2085P0229X 036-105455 IL Primary

Addresses

Primary practice location

225 E Chicago Ave # 9
Chicago, IL 60611-2991

Mailing address

225 E Chicago Ave # 9
Chicago, IL 60611-2991
Phone (312) 227-4500

Other identifiers 1

IdentifierTypeStateIssuer
036105455MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwyers@luriechildrens.org

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
I20111215000697 IL Practitioner - Diagnostic RadiologyPractitioner - Other (Physician) 9638344856 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-105455ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Mar 24, 2015 Accepting new patients
Shriners Hospitals for Children CurrentSince Jun 1, 2020 Accepting new patients
Shriners Hospitals for Children CurrentSince Jun 1, 2020 Accepting new patients
Northwestern Medical Faculty Foundation Pediatric Radiology CurrentSince Mar 24, 2015 Accepting new patients
Cook County Current Accepting new patients
Cook County CurrentSince Mar 4, 2020 Accepting new patients
Cook County Diagnostic Radiology CurrentSince Mar 4, 2020 Accepting new patients
Lurie Children's Medical Group Inc Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

225 E Chicago Ave
#118
Chicago, IL 60611

737 N Michigan Ave
Ste 2040
Chicago, IL 60611

251 E Huron St
#16
Chicago, IL 60611

225 E Chicago Ave
#9
Chicago, IL 60611
Phone (312) 227-4500

2211 N Oak Park Ave
Chicago, IL 60707
Phone (773) 385-5463

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

225 E Chicago Ave
Chicago, IL 60611
Phone (312) 227-6415

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

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.

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1447244496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE # 9",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "312-227-4500",
            "fax_number": "312-227-9785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE # 9",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "312-227-4500",
            "fax_number": "312-227-9785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYERS",
        "first_name": "MARY",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-06",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036-105455",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "IL",
            "license": "036-105455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105455",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwyers@luriechildrens.org",
            "affiliation": "N",
            "address_1": "225 E Chicago Ave # 9",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606112991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.