Krzysztof B Siemionow, M.D.

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

036-123070 Issued in IL

Practice address

12701 W 143Rd St
Suite 200
Homer Glen, IL 60491-7715

Phone

(877) 694-7722

NPI assigned

May 12, 2008

Last updated

Mar 29, 2021By the provider in NPPES

Sex

Male

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Board of Trustees of the University of Illinois

  • Anatomic Pathology Physician
  • Chicago, IL
  • NPI 1386863819
  Medicare reassignment NPD
• The Board of Trustees of the University of Illinois

  dba Occupational Health Service Institute (OHSI)

  • Occupational Medicine Physician
  • Chicago, IL
  • NPI 1043727571
  NPD
• The Board of Trustees of the University of Illinois

  • Primary Podiatric Medicine Podiatrist
  • Chicago, IL
  • NPI 1518185438

  Orthopaedic Surgery of the Spine

  NPD
• Adventist Health Partners, Inc

  dba Glenoaks Anesthesia

  • Anesthesiology Physician
  • Glendale Heights, IL
  • NPI 1912942012
  NPD (past)

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1689841314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12701 W 143RD ST",
            "address_2": "SUITE 200",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604917715",
            "telephone_number": "877-694-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12701 W 143RD ST",
            "address_2": "SUITE 200",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604917715",
            "telephone_number": "877-694-7722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12 Salt Creek Ln Ste 110",
            "address_purpose": "LOCATION",
            "city": "Hinsdale",
            "state": "IL",
            "postal_code": "605218606",
            "country_code": "US",
            "telephone_number": "630-759-1248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIEMIONOW",
        "first_name": "KRZYSZTOF",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-12",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "IL",
            "license": "036-123070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krzysztof.siemionow.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "12 Salt Creek Ln Ste 110",
            "city": "Hinsdale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605218606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shannon Mannix Services Inc (Shannon Mannix Service Inc)
• Erin Shea, MA, LPC
• Sheryl Leipold D.D.S. P.C.
• Lily Shinn, MS, MSW, LCSW
• Renee Ann Shutay, M.A., L.C.P.C.
• Pamela Jean Simon Laporte, P.T.
• Samantha Skinner
• June Smalec, ACNS-BC
• Small Talk Communication LLC
• Christine Smith

• Orthopaedic Surgery of the Spine Physician in Homer Glen, IL
• Providers in Homer Glen, IL by specialty
• Orthopaedic Surgery of the Spine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.