Individual provider Active NPI

John M Tomkowiak, MD

  • Psychiatry Physician
  • North Chicago, IL
National Provider Identifier
1649553751
Registry record updated Oct 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036.091148 Issued in IL
Practice address
3333 Green Bay Rd
North Chicago, IL 60064-3037
Phone
(847) 578-8381
Fax
(847) 578-8319
NPI assigned
Sep 25, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2011

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 036.091148 IL Primary

Addresses

Primary practice location

3333 Green Bay Rd
North Chicago, IL 60064-3037

Mailing address

3333 Green Bay Rd
North Chicago, IL 60064-3037
Phone (847) 578-8381

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20231219001664 WA Practitioner - Psychiatry 2860411659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Southern Illinois University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Department of Social Dept of SHS Div of InstnsGroup PAC ID 9133013725, 23 clinicians

Practice addresses (Care Compare)

850 Maple St
Medical Lake, WA 99022-0800
Phone (509) 565-4000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.091148ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Social Dept of SHS Div of Instns Psychiatry CurrentSince Nov 2, 2023 Accepting new patients
Siu Physicians & Surgeons, Inc Psychiatry PastSince Aug 1, 2021 Accepting new patients

Organizations & group practices 2

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": "1316908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318636800000",
    "number": "1649553751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 GREEN BAY RD",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "600643037",
            "telephone_number": "847-578-8381",
            "fax_number": "847-578-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 GREEN BAY RD",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "600643037",
            "telephone_number": "847-578-8381",
            "fax_number": "847-578-8319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMKOWIAK",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-25",
        "last_updated": "2011-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036.091148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Chicago, IL

Sources for this page

Verify at the official NPI Registry.