Individual provider Active NPI

William Cruikshank, M.D.

  • Internal Medicine Physician
  • Oak Lawn, IL
National Provider Identifier
1639104052
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-081634 Issued in IL
Practice address
6101 W 95TH St
Oak Lawn, IL 60453-2735
Phone
(708) 261-0831
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-081634 IL Primary

Addresses

Primary practice location

6101 W 95TH St
Oak Lawn, IL 60453-2735

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (773) 768-7700

Other practice location 1

100 W 162nd St
South Holland, IL 60473-2003
Phone (708) 730-2200

Other practice location 2

2231 E 95th St
Chicago, IL 60617-4804
Phone (773) 768-7700

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
I20040423000615 IL Practitioner - Internal Medicine 6103728944 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-081634ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients
PMR Illinois Holding, LLC CurrentSince Jan 1, 2022 Accepting new patients
Jessica Petersen DC LTD PastSince Sep 28, 2015 Accepting new patients

Locations

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

2231 E 95th St
Chicago, IL 60617
Phone (773) 768-7700

29373 Network Pl
Chicago, IL 60673

1945 W Wilson Ave
Fl 4
Chicago, IL 60640
Phone (773) 736-6220

2734 W 87th St
Chicago, IL 60652
Phone (773) 918-4700

2545 S Ml King Dr
Chicago, IL 60616
Phone (312) 842-7117

19310 S Halsted St
Glenwood, IL 60425
Phone (708) 300-3132

6101 W 95th St
Oak Lawn, IL 60453
Phone (708) 261-0831

100 W 162nd St
South Holland, IL 60473
Phone (708) 730-2200

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1639104052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "773-768-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532735",
            "telephone_number": "708-261-0831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 W 162nd St",
            "address_purpose": "LOCATION",
            "city": "South Holland",
            "state": "IL",
            "postal_code": "604732003",
            "country_code": "US",
            "telephone_number": "708-730-2200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2231 E 95th St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606174804",
            "country_code": "US",
            "telephone_number": "773-768-7700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRUIKSHANK",
        "first_name": "WILLIAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-081634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.