Lisa C Tybor-Jaraczewski, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036090727 Issued in IL

Practice address

909 Davis St
Suite 200
Evanston, IL 60201-3645

Phone

(847) 866-3700

Fax

(847) 866-3731

NPI assigned

Nov 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882

  Pediatrics

  Medicare reassignment NPD
• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1619042157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "EVANSTON HOSPITAL",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-1206",
            "fax_number": "847-570-1248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 DAVIS ST",
            "address_2": "SUITE 200",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013645",
            "telephone_number": "847-866-3700",
            "fax_number": "847-866-3731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYBOR-JARACZEWSKI",
        "first_name": "LISA",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036090727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ltyborjaraczewski6843@direct.northshore.org",
            "affiliation": "N",
            "address_1": "909 Davis St",
            "address_2": "suite 200",
            "city": "Evanston",
            "state": "IL",
            "country_code": "US",
            "postal_code": "602013645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David Ricki Turok, D.D.S.
• Marlene Morrison Turvill, M.D.
• Howard Norman Tushman, M.D.
• Ashley A Tuttle, MD
• Alison Marie Twite
• Richard Tye, D.D.S.
• Arthur W Tylka, APN-CRNA
• Jennifer Ann Tymkew, ATC
• Benjamin David Tyrrell, M.D.
• Michelle Ubau, FNP-BC

• Pediatrics Physician in Evanston, IL
• Providers in Evanston, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.