Individual provider Active NPI

Renata Krystyna Ciszek, APN

  • Family Nurse Practitioner
  • Elmhurst, IL
National Provider Identifier
1447567268
Registry record updated Apr 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
041337154 Issued in IL
Practice address
429 N York Road
Elmhurst, IL 60126
Phone
(630) 782-4050
Fax
(630) 782-5021
NPI assigned
Sep 1, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 041337154 IL
Family Nurse Practitioner 363LF0000X 041337154 IL Primary

Addresses

Primary practice location

429 N York Road
Elmhurst, IL 60126

Mailing address

1901 S Meyers Road
Suite 350
Oakbrook Terrace, IL 60181
Phone (630) 873-7305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041337154ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Internal Medicine Associates Inc CurrentSince Dec 29, 2012 Accepting new patients
Suburban Home Physicians,LLC Past Accepting new patients
Elmhurst Memorial Hospital Past Accepting new patients

Locations

1500 Shermer Rd
Ste 325E
Northbrook, IL 60062
Phone (847) 498-1515

666 Dundee Rd
Ste 802
Northbrook, IL 60062
Phone (847) 498-1515

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": "1283299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302134400000",
    "number": "1447567268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 S MEYERS ROAD",
            "address_2": "SUITE 350",
            "city": "OAKBROOK TERRACE",
            "state": "IL",
            "postal_code": "60181",
            "telephone_number": "630-873-7305",
            "fax_number": "630-416-3189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 N YORK ROAD",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "60126",
            "telephone_number": "630-782-4050",
            "fax_number": "630-782-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CISZEK",
        "first_name": "RENATA",
        "middle_name": "KRYSTYNA",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-01",
        "last_updated": "2011-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "041337154",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "041337154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2011; 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.