NPIMap

Individual provider Active NPI

Larisa Georgy Ciatlos-Deak, MD

  • Family Medicine Physician
  • Decatur, IL
National Provider Identifier
1497283774
Registry record updated Jul 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036153610 Issued in IL
Practice address
4965 E Lost Bridge Rd
Decatur, IL 62521-5139
Phone
(217) 864-5531
Fax
(217) 864-2449
NPI assigned
May 31, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036153610 IL Primary

Addresses

Primary practice location

4965 E Lost Bridge Rd
Decatur, IL 62521-5139

Mailing address

4965 E Lost Bridge Rd
Decatur, IL 62521-5139
Phone (217) 864-5531

Other names 1

  • Ms. Larisa Rudica Deak Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200728003439 IL Practitioner - Family Practice 9638437809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Medical Group IncGroup PAC ID 5092857821, 212 clinicians

Practice addresses (Care Compare)

4965 E Lost Bridge Rd
Decatur, IL 62521-5139
Phone (217) 864-5531

Hospital & facility affiliations

  • HSHS Home Care Illinois Home health agency, Effingham, IL, CCN 147661
  • Advanced Healthcare Services, LLC Home health agency, Springfield, IL, CCN 147945
  • St Marys Hospital Hospital, Decatur, IL, CCN 140166
  • Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135
  • St Johns Hospital Hospital, Springfield, IL, CCN 140053

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
HSHS Medical Group Inc Family Medicine CurrentSince Sep 7, 2020 Accepting new patients
HSHS Medical Group Inc CurrentSince Sep 7, 2020 Accepting new patients
HSHS Medical Group Inc Current Accepting new patients
HSHS Medical Group Inc Past Accepting new patients

Locations

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

4965 E Lost Bridge Rd
Decatur, IL 62521
Phone (217) 321-9321

3051 Hollis Dr
Fl 2
Springfield, IL 62704
Phone (217) 321-9321

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 5

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": "1496188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1497283774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4965 E LOST BRIDGE RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625215139",
            "telephone_number": "217-864-5531",
            "fax_number": "217-864-2449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4965 E LOST BRIDGE RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625215139",
            "telephone_number": "217-864-5531",
            "fax_number": "217-864-2449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIATLOS-DEAK",
        "first_name": "LARISA",
        "middle_name": "GEORGY",
        "name_prefix": "Miss",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-31",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036153610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARISA",
            "last_name": "DEAK",
            "middle_name": "RUDICA",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.