Individual provider Active NPI

Henryk Roztoczynski, M.D., PH.D.

  • Adult Medicine Physician
  • Chicago, IL
National Provider Identifier
1457430415
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
036058369 Issued in IL
Practice address
6157 W Belmont Ave
Chicago, IL 60634-4004
Phone
(773) 745-8434
Fax
(773) 745-3443
NPI assigned
Nov 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 036058369 IL Primary

Addresses

Primary practice location

6157 W Belmont Ave
Chicago, IL 60634-4004

Mailing address

6157 W Belmont Ave
Chicago, IL 60634-4004
Phone (773) 745-8434

Other identifiers 2

IdentifierTypeStateIssuer
31600059OtherILBCBS
036058369MedicaidIL

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)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine, Doctor of Philosophy

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457430415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6157 W BELMONT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606344004",
            "telephone_number": "773-745-8434",
            "fax_number": "773-745-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6157 W BELMONT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606344004",
            "telephone_number": "773-745-8434",
            "fax_number": "773-745-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROZTOCZYNSKI",
        "first_name": "HENRYK",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "IL",
            "license": "036058369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "31600059",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036058369",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.