Individual provider Active NPI

Elena Grebenciucova, M.D.

  • Neurology Physician
  • Chicago, IL
National Provider Identifier
1467708305
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036172579 Issued in IL
Practice address
675 N Saint Clair St Ste 20-100
Chicago, IL 60611-5970
Phone
(312) 908-4886
NPI assigned
Jul 30, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 126050901 IL
Neurology Physician 2084N0400X 125060901 IL
Neurology Physician 2084N0400X MD457658 PA
Neurology Physician 2084N0400X 036172579 IL Primary

Addresses

Primary practice location

675 N Saint Clair St Ste 20-100
Chicago, IL 60611-5970

Mailing address

675 N Saint Clair St Ste 20-100
Chicago, IL 60611-5970
Phone (312) 908-4886

Other practice location 1

3400 Spruce St
3 W. Gates Bldg
Philadelphia, PA 19104-4238
Phone (215) 662-3370

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
I20170731003587 IL Practitioner - Neurology 8022311059 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Brody School of Medicine at East Carolina University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

675 N St Clair
100 Dept of Neurology
Chicago, IL 60611-5975
Phone (312) 695-7950

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
126050901ILMDInternal Medicine Physician
036172579ILMDNeurology Physician
125060901ILMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jul 6, 2017 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 6, 2017 Accepting new patients
Central Dupage Physician Group Internal Medicine Past Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

675 N Saint Clair St
Ste 20-100
Chicago, IL 60611
Phone (312) 695-4360

259 E Erie St
Ste 1900
Chicago, IL 60611

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

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.

Hospital & facility affiliations 7

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": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1467708305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 20-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115970",
            "telephone_number": "312-908-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 20-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115970",
            "telephone_number": "312-908-4886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Spruce St",
            "address_2": "3 W. Gates Bldg",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044238",
            "country_code": "US",
            "telephone_number": "215-662-3370",
            "fax_number": "215-662-3362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREBENCIUCOVA",
        "first_name": "ELENA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-30",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "126050901",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "125060901",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD457658",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036172579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.