NPIMap

Individual provider Active NPI

Lisa Merle Peck, M.D.

  • Internal Medicine Physician
  • Deerfield, IL
National Provider Identifier
1679539563
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036086705 Issued in IL
Practice address
350 S Waukegan Rd Ste 100&200
Deerfield, IL 60015-5239
Phone
(847) 535-7157
Fax
(224) 271-4332
NPI assigned
Apr 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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 036-086705 IL
Internal Medicine Physician 207R00000X 036086705 IL Primary

Addresses

Primary practice location

350 S Waukegan Rd Ste 100&200
Deerfield, IL 60015-5239

Mailing address

3220 W Il Route 60
Mundelein, IL 60060
Phone (847) 837-8442

Other practice location 1

3220 W IL Route 60
Mundelein, IL 60060
Phone (847) 837-8442

Other identifiers 2

IdentifierTypeStateIssuer
036086705MedicaidIL
036-086705MedicaidIL

Other names 1

  • Lisa Merle Peck-Rosen Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address lpeck205837@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081002000631 IL Practitioner - Internal Medicine 3779651823 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rush Medical College of Rush University, 1990
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)

350 S Waukegan Rd
Suite 200
Deerfield, IL 60015-5239
Phone (312) 926-6146

Hospital & facility affiliations

  • Assure Home Healthcare, Inc Home health agency, Libertyville, IL, CCN 147794
  • Advocate Home Health Care Serv Home health agency, Oakbrook, IL, CCN 147150
  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
  • Advocate Condell Medical Center Hospital, Libertyville, IL, CCN 140202
  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-086705ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Jul 11, 2016 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2023 Accepting new patients
Advocate Health & Hospitals Corp. CurrentSince Jul 11, 2016 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Central Dupage Physician Group Internal Medicine PastSince Sep 17, 2023 Accepting new patients

Locations

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

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

Dept 5777
Carol Stream, IL 60122

29373 Network Pl
Chicago, IL 60673

350 S Waukegan Rd
Ste 100200
Deerfield, IL 60015
Phone (312) 695-4525

350 S Waukegan Rd
Ste 100
Deerfield, IL 60015
Phone (847) 926-0106

350 S Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 350-7297

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

3220 W Il Route 60
Mundelein, IL 60060
Phone (847) 549-7777

560 N Midlothian Rd
Ste 400
Mundelein, IL 60060
Phone (847) 837-8442

Organizations & group practices 6

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 10

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": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1679539563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 W IL ROUTE 60",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "60060",
            "telephone_number": "847-837-8442",
            "fax_number": "847-837-8542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 S WAUKEGAN RD STE 100&200",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600155239",
            "telephone_number": "847-535-7157",
            "fax_number": "224-271-4332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3220 W IL Route 60",
            "address_purpose": "LOCATION",
            "city": "Mundelein",
            "state": "IL",
            "postal_code": "60060",
            "country_code": "US",
            "telephone_number": "847-837-8442",
            "fax_number": "847-837-8542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PECK",
        "first_name": "LISA",
        "middle_name": "MERLE",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-086705",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036086705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086705",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-086705",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lpeck205837@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3220 W IL Route 60",
            "city": "Mundelein",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3220 W IL Route 60",
            "city": "Mundelein",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "PECK-ROSEN",
            "middle_name": "MERLE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Deerfield, IL

Sources for this page

Verify at the official NPI Registry.