Individual provider Active NPI

Bryn Laubacher, DPM

  • Foot & Ankle Surgery Podiatrist
  • Maywood, IL
National Provider Identifier
1548622012
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016005846 Issued in IL
Practice address
2160 S 1St Ave
Maywood, IL 60153-3328
Phone
(708) 216-9000
NPI assigned
Mar 24, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 016005846 IL
Foot & Ankle Surgery Podiatrist 213ES0103X 016005846 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Maywood, IL 60153-3328

Mailing address

2160 S 1St Ave
Maywood, IL 60153-3328

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address blaubacher82971@direct.luhs.org Direct LOYOLA UNIVERSITY MEDICAL CENTER

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190829004201 IL Practitioner - Podiatry 7911290630 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Loyola University Medical CenterGroup PAC ID 3779488903, 917 clinicians

Practice addresses (Care Compare)

2160 S 1St Ave
Maywood, IL 60153-3328
Phone (708) 216-9000

Hospital & facility affiliations

  • Loyola University Medical Center Hospital, Maywood, IL, CCN 140276
  • Loyola Gottlieb Memorial Hospital Hospital, Melrose Park, IL, CCN 140008

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue30
Removal of nail tissue179
Removal or shaving of skin growth14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016005846ILMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center CurrentSince Aug 1, 2021 Accepting new patients
Loyola University Medical Center CurrentSince Aug 1, 2021 Accepting new patients
Loyola University Medical Center Current Accepting new patients
Northwest Podiatry Center Foot & Ankle Surgery CurrentSince Sep 1, 2019 Accepting new patients
Northwest Podiatry Center CurrentSince Sep 1, 2019 Accepting new patients

Locations

2124 Ogden Ave
Ste 101
Aurora, IL 60504
Phone (630) 585-8087

3254 Sycamore Rd
DeKalb, IL 60115
Phone (815) 756-9491

500 W Court St
Kankakee, IL 60901
Phone (800) 585-4119

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

7954 W Oakton St
Niles, IL 60714
Phone (708) 823-5510

1S260 Summit Ave
Oakbrook Terrace, IL 60181
Phone (630) 953-6600

31 S Sutton Rd
Streamwood, IL 60107
Phone (630) 830-2155

2 Westbrook Corporate Ctr
Ste 600
Westchester, IL 60154
Phone (708) 216-5092

705 Warrenville Rd
Ste B
Wheaton, IL 60189
Phone (630) 668-8277

Organizations & group practices 5

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 3

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": "1458777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1548622012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUBACHER",
        "first_name": "BRYN",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-24",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016005846",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "blaubacher82971@direct.luhs.org",
            "affiliation": "Y",
            "affiliationName": "LOYOLA UNIVERSITY MEDICAL CENTER",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2160 S 1st Ave",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601533328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.