Individual provider Active NPI

Marianne Kwiatkowski, NP

  • Gerontology Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1750307963
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
209.001854 Issued in IL
Practice address
850 W 63D Street
Chicago, IL 60621
Phone
(773) 377-7304
Fax
(773) 634-7965
NPI assigned
Jul 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 209.001854 IL Primary

Addresses

Primary practice location

850 W 63D Street
Chicago, IL 60621

Mailing address

PO Box 746715
Atlanta, GA 30374-6715
Phone (773) 352-1515

Other practice location 1

4600 N Ravenswood Ave
2nd Floor
Chicago, IL 60640-4510
Phone (773) 561-7956

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070112000257 IL Practitioner - Nurse Practitioner 9638179740 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Street Health Physicians Group PCGroup PAC ID 7517109879, 227 clinicians

Practice addresses (Care Compare)

850 W 63Rd St
Chicago, IL 60621-1902
Phone (312) 733-9730

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.001854ILMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Street Health Physicians Group, PC Nurse Practitioner CurrentSince Nov 9, 2020 Accepting new patients
Quality Health Unlimited,P.C. Nurse Practitioner Past Accepting new patients
Advocate North Side Health Network Past Accepting new patients

Locations

850 W 63rd St
Chicago, IL 60621
Phone (773) 377-7304

4848 W Irving Park Rd
Chicago, IL 60641
Phone (773) 724-6200

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1750307963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746715",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746715",
            "telephone_number": "773-352-1515",
            "fax_number": "312-929-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W 63D STREET",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60621",
            "telephone_number": "773-377-7304",
            "fax_number": "773-634-7965"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4600 N Ravenswood Ave",
            "address_2": "2nd Floor",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606404510",
            "country_code": "US",
            "telephone_number": "773-561-7956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWIATKOWSKI",
        "first_name": "MARIANNE",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209.001854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.