Individual provider Active NPI

John Anthony Cieslak III, M.D., PH.D.

  • Diagnostic Radiology Physician
  • Evanston, IL
National Provider Identifier
1740574748
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036.142179 Issued in IL
Practice address
2650 Ridge Ave.
Dept. of Radiology
Evanston, IL 60201-1057
Phone
(847) 570-2942
NPI assigned
Jun 7, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 036142179 IL
Diagnostic Radiology Physician 2085R0202X 036.142179 IL Primary

Addresses

Primary practice location

2650 Ridge Ave.
Dept. of Radiology
Evanston, IL 60201-1057

Mailing address

2650 Ridge Ave.
Dept. of Radiology
Evanston, IL 60201-1057
Phone (847) 570-2942

Other practice location 1

676 N Saint Clair St
Suite 800 Northwestern Medicine-Department of Radiology
Chicago, IL 60611-2927
Phone (312) 695-5753

Other practice location 2

1725 W Harrison St
Chicago, IL 60612-3841
Phone (312) 563-4238

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220420002268 IL Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 3870898091 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
Northwestern University Feinberg Medical School, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Suite 2218a
Evanston, IL 60201-1700
Phone (847) 503-4222

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
  • Swedish Hospital Hospital, Chicago, IL, CCN 140114
  • The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.142179ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince May 1, 2022 Accepting new patients
Endeavor Health Medical Group CurrentSince May 1, 2022 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

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.

Hospital & facility affiliations 3

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": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1740574748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE.",
            "address_2": "DEPT. OF RADIOLOGY",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011057",
            "telephone_number": "847-570-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE.",
            "address_2": "DEPT. OF RADIOLOGY",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011057",
            "telephone_number": "847-570-2942"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "676 N Saint Clair St",
            "address_2": "Suite 800 Northwestern Medicine-Department of Radiology",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606112927",
            "country_code": "US",
            "telephone_number": "312-695-5753",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1725 W Harrison St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123841",
            "country_code": "US",
            "telephone_number": "312-563-4238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CIESLAK",
        "first_name": "JOHN",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-07",
        "last_updated": "2022-04-13",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IL",
            "license": "036142179",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036.142179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.