Individual provider Active NPI

Jack N Powitz, MD

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1558490433
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Practice address
4700 N Western Ave
Ste. 1B
Chicago, IL 60625-2081
Phone
(773) 334-8580
Fax
(773) 334-8590
NPI assigned
Mar 5, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X IL Primary

Addresses

Primary practice location

4700 N Western Ave
Ste. 1B
Chicago, IL 60625-2081

Mailing address

4700 N Western Ave
Ste. 1B
Chicago, IL 60625-2081
Phone (773) 334-8580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 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
I20070606000012 IL Practitioner - Psychiatry 7012015639 Reassigns benefits to 1 organization
I20180521002167 WI Practitioner - Psychiatry 7012015639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Total Care Solutions, SCGroup PAC ID 6002090933, 11 clinicians

Practice addresses (Care Compare)

101 Main St
Park Forest, IL 60466-2375
Phone (708) 283-2921

1370 Ring Rd
Calumet City, IL 60409-5428
Phone (708) 730-0994

2242 N Kedzie Blvd
Chicago, IL 60647-2504
Phone (773) 486-7700

310 Banbury Rd
North Aurora, IL 60542-1260
Phone (630) 892-7627

707 W Riverside Blvd
Rockford, IL 61103-2125
Phone (815) 877-5752

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.52 of 100Reported as group
Quality
0
Promoting interoperability
100
Improvement activities
40
Cost
78.4

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Total Care Solutions, SC CurrentSince May 17, 2020 Accepting new patients
BCS of Wisconsin S.C. Psychiatry CurrentSince Mar 26, 2018 Accepting new patients
Care Advocate Psychiatric Management, Inc. Psychiatry Past Accepting new patients

Locations

1 Westbrook Corporate Ctr
Ste 300
Westchester, IL 60154
Phone (630) 709-1501

39465 W 14 Mile Rd
Novi, MI 48377
Phone 24885939000

2717 N Grandview Blvd
Ste 102
Waukesha, WI 53188
Phone (262) 513-0700

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558490433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 N WESTERN AVE",
            "address_2": "STE. 1B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252081",
            "telephone_number": "773-334-8580",
            "fax_number": "773-334-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N WESTERN AVE",
            "address_2": "STE. 1B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252081",
            "telephone_number": "773-334-8580",
            "fax_number": "773-334-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWITZ",
        "first_name": "JACK",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.