Philip Sebastian Maciukiewicz, M.D.

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

036.158461 Issued in IL

Practice address

2160 S First Avenue
Building 103 Room 3107
Maywood, IL 60153

Phone

(708) 216-9169

Fax

(708) 216-1249

NPI assigned

Apr 5, 2019

Reactivated

Nov 27, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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

Specialty

Anesthesiology

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Otero County Hospital AssociationGroup PAC ID 3173516606, 245 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Southern New Mexico Hospital, Alamogordo, NM, CCN 320004
• Lincoln County Medical Center Hospital, Ruidoso, NM, CCN 321306

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pmaciukiewicz102014@direct.luhs.org
• Direct secure messaging: philip.maciukiewicz.1@6965.direct.athenahealth.com

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.

• Otero County Hospital Association

  • General Acute Care Hospital
  • Alamogordo, NM
  • NPI 1861450579
  Medicare reassignment Care Compare group NPD
• Loyola University Medical Center

  • General Acute Care Hospital
  • Maywood, IL
  • NPI 1376521575
  NPD
• Otero County Hospital Association

  • Community/Retail Pharmacy
  • Alamogordo, NM
  • NPI 1235948803
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Otero County Hospital Association

  • General Acute Care Hospital
  • Alamogordo, NM
  • NPI 1861450579
  Care Compare affiliation
• Presbyterian Healthcare Services

  • Critical Access Hospital
  • Ruidoso, NM
  • NPI 1558347708
  Care Compare affiliation

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

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1619439809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S FIRST AVENUE",
            "address_2": "BUILDING 103 ROOM 3107",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-9169",
            "fax_number": "708-216-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S FIRST AVENUE",
            "address_2": "BUILDING 103 ROOM 3107",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-9169",
            "fax_number": "708-216-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACIUKIEWICZ",
        "first_name": "PHILIP",
        "middle_name": "SEBASTIAN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-05",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "deactivation_date": "2019-11-07",
        "reactivation_date": "2019-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "125.074702",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "IL",
            "license": "036.158461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Maalouf, MD
• Jamie Rose Mabrey
• Gregory Paul Macaluso, M.D.
• Rehaan Machhi
• Mary Macis, RN, APN
• Ronald Mack
• Stephen Macleod, DDS, MS
• Jack Richard Maddalozzo, DMD
• Abaigael Paige Madden, MD
• Erin Madden, MD

• Pain Medicine Physician in Maywood, IL
• Providers in Maywood, IL by specialty
• Pain Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.