Individual provider Active NPI

Denise Petenzi, DPM

  • Podiatrist
  • Chicago, IL
National Provider Identifier
1457329708
Registry record updated Sep 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
016-005107 Issued in IL
Practice address
3758W Chicago Ave
Chicago, IL 60651-3823
Phone
(312) 505-0156
Fax
(773) 529-3911
NPI assigned
Mar 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 016-005107 IL Primary

Addresses

Primary practice location

3758W Chicago Ave
Chicago, IL 60651-3823

Mailing address

2644 N Wayne Ave
Unit C
Chicago, IL 60614
Phone (312) 505-0156

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040330001654 IL Practitioner - Podiatry 6406848662 Reassigns benefits to 1 organization
Practice locations: Joliet, IL; Chicago, IL

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2644 N Wayne Ave
Apt C
Chicago, IL 60614-6783
Phone (312) 505-0156

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
34.54 of 100Reported as individual
Quality
59.07
Improvement activities
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue32
Removal of skin lesions1-10
Removal of nail tissue1874
Removal or shaving of skin growth579

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016-005107ILMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Denise J Petenzi, DPM, LLC Podiatrist CurrentSince Jan 14, 2024 Accepting new patients
Fabian Carbonell MD SC Past Accepting new patients
Autumn Country Club, Inc. Past Accepting new patients
Edgewater Beach Foot and Ankle Center, P.C. PastSince Aug 2, 2020 Accepting new patients

Locations

3758 W Chicago Ave
Chicago, IL 60651
Phone (312) 235-0626

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1142035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441152000000",
    "number": "1457329708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2644 N WAYNE AVE",
            "address_2": "UNIT C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60614",
            "telephone_number": "312-505-0156",
            "fax_number": "773-529-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3758W CHICAGO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606513823",
            "telephone_number": "312-505-0156",
            "fax_number": "773-529-3911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETENZI",
        "first_name": "DENISE",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-11",
        "last_updated": "2015-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016-005107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.