Individual provider Active NPI

Marek Gawrysz, MD

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1508818055
Registry record updated Sep 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
336031676 Issued in IL
Practice address
6318 W Irving Park Road
Chicago, IL 60634
Phone
(773) 286-1717
Fax
(773) 286-0440
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2015

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 336031676 IL Primary

Addresses

Primary practice location

6318 W Irving Park Road
Chicago, IL 60634

Mailing address

6318 W Irving Park Road
Chicago, IL 60634
Phone (773) 286-1717

Other identifiers 1

IdentifierTypeStateIssuer
036067472MedicaidIL

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
I20090506000234 IL Practitioner - Family Practice 3173671807 Practice locations: Chicago, IL

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6318 W Irving Park Rd
Chicago, IL 60634-2405
Phone (773) 286-1717

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
336031676ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
First Aid Clinic LLC Family Medicine PastSince Nov 1, 2015 Accepting new patients
DX Physical Therapy & Rehabilitation, LTD. PastSince Nov 5, 2011 Accepting new patients
Grand Medical Clinic, Inc Past Accepting new patients
Proper Balance Healthcare PastSince Aug 10, 2015 Accepting new patients

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442361600000",
    "number": "1508818055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6318 W IRVING PARK ROAD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60634",
            "telephone_number": "773-286-1717",
            "fax_number": "773-286-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6318 W IRVING PARK ROAD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60634",
            "telephone_number": "773-286-1717",
            "fax_number": "773-286-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAWRYSZ",
        "first_name": "MAREK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2015-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "336031676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067472",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.