Individual provider Active NPI

Lisa Diane Wilsbacher, M.D. PH.D.

  • Cardiovascular Disease Physician
  • Chicago, IL
National Provider Identifier
1609889690
Registry record updated Mar 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036137176 Issued in IL
Practice address
675 N Saint Clair St
Galter Suite 19-100
Chicago, IL 60611-5975
Phone
(312) 664-3278
Fax
(312) 695-5774
NPI assigned
Aug 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036137176 IL
Cardiovascular Disease Physician 207RC0000X 036137176 IL Primary

Addresses

Primary practice location

675 N Saint Clair St
Galter Suite 19-100
Chicago, IL 60611-5975

Mailing address

675 N Saint Clair St
Galter Suite 19-100
Chicago, IL 60611-5975
Phone (312) 664-3278

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
I20150416000631 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1456496694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Northwestern University Feinberg Medical School, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

1630 Sherman Ave
Evanston, IL 60201-3711

250 E Superior
2304 Nwmff Prent WMN Hosp
Chicago, IL 60611-2914
Phone (312) 472-3660

250 E Superior St
Chicago, IL 60611-2914

251 E Huron
Chicago, IL 60611-2908

251 E Huron St
Chicago, IL 60611-2908

4445 W Irving Park Rd
Chicago, IL 60641-2808

636 Raymond Dr
Suite 107
Naperville, IL 60563-9789
Phone (630) 416-2300

660 N Westmoreland Rd
302 Lake Forest OBGYN
Lake Forest, IL 60045-1673
Phone (312) 926-6146

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Northwestern Medicine McHenry Hospital, McHenry, IL, CCN 140116
  • Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036137176ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Mar 11, 2015 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Mar 11, 2015 Accepting new patients
Central Dupage Physician Group Internal Medicine Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

675 N Saint Clair St
Ste 19-100
Chicago, IL 60611
Phone (312) 664-3278

680 N Lake Shore Dr
Ste 810
Chicago, IL 60611
Phone (312) 926-8811

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

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 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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426464000000",
    "number": "1609889690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST",
            "address_2": "GALTER SUITE 19-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115975",
            "telephone_number": "312-664-3278",
            "fax_number": "312-695-5774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST",
            "address_2": "GALTER SUITE 19-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115975",
            "telephone_number": "312-664-3278",
            "fax_number": "312-695-5774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSBACHER",
        "first_name": "LISA",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "M.D. PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2015-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036137176",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036137176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.