Therese Marie Lucietto-Sieradzki, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036102862 Issued in IL

Practice address

205 Cadillac CT Ste 7
Belvidere, IL 61008-1733

Phone

(815) 544-0087

Fax

(815) 544-0088

NPI assigned

Jul 9, 2006

Last updated

Jun 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL, WI2 enrollments

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 2

Specialty

Family Practice

Education

Northwestern University Feinberg Medical School, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beloit Health System IncGroup PAC ID 8224947858, 138 clinicians

Saint Anthony Medical CenterGroup PAC ID 5496654006, shared by 4 NPIs, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sanctuary Hospice Hospice, Westchester, IL, CCN 141648
• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• Saint Anthony Medical Center Hospital, Rockford, IL, CCN 140233

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.

• Your Family Doctor, LLC

  • Family Medicine Physician
  • Belvidere, IL
  • NPI 1942219514
  Medicare reassignment NPD Authorized official
• Beloit Health System Inc

  dba BHS Clinics

  • General Practice Physician
  • Beloit, WI
  • NPI 1679616361

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Rosecrance Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockford, IL
  • NPI 1013289446
  Medicare reassignment NPD
• Saint Anthony Medical Center

  dba OSF Saint Anthony Medical Center

  • Hematology & Oncology Physician
  • Rockford, IL
  • NPI 1942248802
  Medicare reassignment
• Rosecrance Inc

  dba Rosecrance Harrison - Men's

  • Substance Abuse Rehabilitation Facility
  • Rockford, IL
  • NPI 1548247349
  NPD
• Rosecrance Inc

  dba Rosecrance

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moline, IL
  • NPI 1639892698
  NPD
• Beloit Clinic, S.C.

  • Internal Medicine Physician
  • Beloit, WI
  • NPI 1548345887

  Family Medicine

  NPD
• Beloit Health System, Inc

  dba Hendricks Family Heart Hospital

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Beloit, WI
  • NPI 1568677417
  NPD
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• The Board of Trustees of the University of Illinois

  dba Uic Merit

  • Pediatrics Physician
  • Rockford, IL
  • NPI 1972541902

  Family Medicine

  NPD (past)

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

• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation
• Hospice of Greater Chicago, LLC

  dba Sanctuary Hospice

  • Community Based Hospice Care Agency
  • Westchester, IL
  • NPI 1124418041
  Care Compare affiliation
• Saint Anthony Medical Center

  dba OSF Saint Anthony Medical Center

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1790739977
  Care Compare affiliation

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1699708636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 298",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610080298",
            "telephone_number": "815-544-0087",
            "fax_number": "815-544-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 CADILLAC CT STE 7",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610081733",
            "telephone_number": "815-544-0087",
            "fax_number": "815-544-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCIETTO-SIERADZKI",
        "first_name": "THERESE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036102862",
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "IL",
            "license": "036102862",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ID",
            "identifier": "07132017",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102862",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID RURAL HEALTH ID",
            "identifier": "201772810001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-RIVERBEND ID",
            "identifier": "148976",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joan M Lodge, LCSW
• Deanna M Longley, P.T.
• Cassandra Lopez, MD
• Thomas A Losure, DO
• David R Love, ATC, CSCS
• Sarah Lyons, APN
• Clayton R. Malaker, M.D.
• Malcolm Pediatric Dentistry
• Andy J Malcolm, DDS
• Maple Crest Care Centre LLC

• Family Medicine Physician in Belvidere, IL
• Providers in Belvidere, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.