Individual provider Active NPI

Nancy Gryniewicz, M.D.

  • Family Medicine Physician
  • Oak Park, IL
National Provider Identifier
1558368043
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036089707 Issued in IL
Practice address
965 Lake St
Oak Park, IL 60301-1292
Phone
(708) 383-0400
Fax
(708) 383-4314
NPI assigned
Jun 30, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2022

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 036089707 IL Primary

Addresses

Primary practice location

965 Lake St
Oak Park, IL 60301-1292

Mailing address

965 Lake St
Oak Park, IL 60301-1292
Phone (708) 383-0400

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
I20100830000312 IL Practitioner - Family Practice 3274657150 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dynamic Physical Therapy, Inc.Group PAC ID 4284607680, 41 clinicians
Family Medical Care, LTDGroup PAC ID 8729102603, 2 clinicians

Practice addresses (Care Compare)

1049 Lake St
Suite 201
Oak Park, IL 60301-6708

965 Lake St
Oak Park, IL 60301-1292
Phone (708) 383-0400

Hospital & facility affiliations

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

State licenses

LicenseStateTypeSpecialty
036089707ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medical Care, LTD Family Medicine CurrentSince Sep 1, 2002 Accepting new patients

Locations

965 Lake St
Oak Park, IL 60301
Phone (708) 383-0400

965 Lake St
Ste 2
Oak Park, IL 60301

Organizations & group practices 2

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": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1558368043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011292",
            "telephone_number": "708-383-0400",
            "fax_number": "708-383-4314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011292",
            "telephone_number": "708-383-0400",
            "fax_number": "708-383-4314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRYNIEWICZ",
        "first_name": "NANCY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-30",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036089707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

Verify at the official NPI Registry.