NPIMap

Rebecca J Andersen, MD

Individual provider Active NPI Emergency Medicine Physician · McHenry, IL

NPI 1699848705 · NPPES record last updated May 14, 2018

Key facts

NPI
1699848705
Entity type
Individual (NPI type 1)
Primary specialty
Emergency Medicine Physician 207P00000X
License
036118364 (IL)
Practice address
4201 W Medical Center Dr
McHenry, IL 60050
Phone
(815) 759-3100
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 16

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 1

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

Medicare Care Compare profile

Specialty
Emergency Medicine
Education
State University of Ny Upstate Medical University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwestern Medical Faculty Foundation (4,386 clinicians)

Practice addresses (Care Compare)

10400 Haligus Rd
Huntley, IL 60142-9553

4309 W Medical Ctr Dr
Suite A200
McHenry, IL 60050-8437
Phone (815) 759-8070

515 Valley View Dr
Suite 201
Moline, IL 61265-6175
Phone (312) 695-0870

Hospital & facility affiliations

  • Northwestern Medicine McHenry Hospital · McHenry, IL · CCN 140116

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100 (apm)
Quality
83.05
Promoting interoperability
100
Improvement activities
40

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20070824000859 IL Practitioner - Emergency Medicine 3678679750 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation Current
since Apr 20, 2021		 Accepting new patients
Northwestern Medical Faculty Foundation Current
since Apr 20, 2021		 Accepting new patients
Emergency Medicine Physicians of Cortland County, PLLC Emergency Medicine Past Accepting new patients

Locations

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

Dept 5777
Carol Stream, IL 60122

11650 S State Route 47
Huntley, IL 60142
Phone (847) 802-7300

10400 Haligus Rd
Huntley, IL 60142
Phone (224) 654-0000

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4201 W Medical Center Dr
McHenry, IL 60050
Phone (815) 759-3100

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 242008 NY
Emergency Medicine Physician 207P00000X 036118364 IL Yes

Addresses

Primary practice location

4201 W Medical Center Dr
McHenry, IL 60050

Mailing address

4201 W Medical Center Dr
McHenry, IL 60050-8409
Phone (815) 759-3100

Other identifiers

IdentifierTypeStateIssuer
036118364OtherILSTATE LICENSE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 14, 2018.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526256000000",
    "number": "1699848705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 W MEDICAL CENTER DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508409",
            "telephone_number": "815-759-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 W MEDICAL CENTER DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "60050",
            "telephone_number": "815-759-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "REBECCA",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2018-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "242008",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036118364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036118364",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

All providers in McHenry, IL · Emergency Medicine Physician in Illinois

Sources for this page

Verify at the official NPI Registry.