Individual provider Active NPI

Jay Foster Wigboldy, MD

  • Diagnostic Radiology Physician
  • Indianapolis, IN
National Provider Identifier
1487636569
Registry record updated Jan 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01079663A Issued in IN
Practice address
5901 Technology Center Dr
Indianapolis, IN 46278-6013
Phone
(317) 972-9669
Fax
(317) 715-9990
NPI assigned
Nov 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 01079663A IN Primary
Diagnostic Radiology Physician 2085R0202X 34489 KY
Diagnostic Radiology Physician 2085R0202X 036144663 IL

Addresses

Primary practice location

5901 Technology Center Dr
Indianapolis, IN 46278-6013

Mailing address

5901 Technology Center Dr
Indianapolis, IN 46278-6013
Phone (317) 972-9669

Other practice location 1

801 S Milwaukee Ave
Libertyville, IL 60048-3204
Phone (847) 362-2900

Other identifiers 1

IdentifierTypeStateIssuer
300055776MedicaidIN

Electronic endpoints 3

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network
Direct Messaging Address jwigboldy445485@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180403000750 IL Practitioner - Diagnostic Radiology 1850335225 Reassigns benefits to 2 organizations
I20211105001757 IN Practitioner - Diagnostic Radiology 1850335225 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Indiana University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1775 Dempster St
Park Ridge, IL 60068-1143

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

801 S Milwaukee Ave
Libertyville, IL 60048-3204
Phone (847) 279-0061

801 S Milwaukee Ave BLDG
Suite 880
Libertryville, IL 60048-3204
Phone (847) 990-5910

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
68 of 100Reported as group
Quality
80
Improvement activities
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036144663ILMDDiagnostic Radiology Physician
01079663AINMDDiagnostic Radiology Physician
34489KYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Dec 18, 2025 Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Dec 18, 2025 Accepting new patients
Northwest Radiology Network P C Diagnostic Radiology CurrentSince Dec 1, 2021 Accepting new patients
Central Illinois Radiological Associates, LTD. Diagnostic Radiology CurrentSince Feb 3, 2018 Accepting new patients
Roswell Clinic Corp Past Accepting new patients
Cira Michigan PC Diagnostic Radiology Past Accepting new patients
Tri-State Radiology, P.C. Diagnostic Radiology Past Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

5200 Reliable Pkwy
Chicago, IL 60686
Phone (309) 671-8748

5900 Bond Ave
East Saint Louis, IL 62207
Phone (618) 332-3060

801 S Milwaukee Ave
Libertyville, IL 60048
Phone (847) 362-2900

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

111 Oakwood Rd
Peoria, IL 61611
Phone (586) 412-4144

10603 N Meridian St
Carmel, IN 46290
Phone (317) 415-6050

5901 Technology Center Dr
Indianapolis, IN 46278
Phone (317) 328-4777

Interoperability endpoints

  • Direct secure messaging: jwigboldy445485@direct.myadvocateaurora.org

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769040000000",
    "number": "1487636569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 TECHNOLOGY CENTER DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462786013",
            "telephone_number": "317-972-9669",
            "fax_number": "317-715-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 TECHNOLOGY CENTER DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462786013",
            "telephone_number": "317-972-9669",
            "fax_number": "317-715-9990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 S Milwaukee Ave",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600483204",
            "country_code": "US",
            "telephone_number": "847-362-2900",
            "fax_number": "847-990-5292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIGBOLDY",
        "first_name": "JAY",
        "middle_name": "FOSTER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01079663A",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KY",
            "license": "34489",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036144663",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300055776",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwigboldy445485@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "801 S Milwaukee Ave",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600483204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "801 S Milwaukee Ave",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600483204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.