Individual provider Active NPI

Rachelle Camaya Centeno, D.O.

  • Diagnostic Radiology Physician
  • Tinley Park, IL
National Provider Identifier
1780827337
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036.138511 Issued in IL
Practice address
17495 La Grange Rd
Tinley Park, IL 60487-7581
Phone
(708) 226-7000
Fax
(708) 226-7014
NPI assigned
Apr 13, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 036.138511 IL Primary

Addresses

Primary practice location

17495 La Grange Rd
Tinley Park, IL 60487-7581

Mailing address

PO Box 713260
Chicago, IL 60677-1260
Phone (630) 469-9200

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rcenteno212869@direct.edward.org
Direct Messaging Address rcenteno212869@dulyhealthandcare.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 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

Enrollment IDStateProvider typePAC IDDetails
I20150831002115 IL Practitioner - Diagnostic Radiology 6406074228 Reassigns benefits to 2 organizations
I20220919000637 IN Practitioner - Diagnostic Radiology 6406074228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dupage Medical Group LTDGroup PAC ID 5496667941, 1,326 clinicians
The South Bend Clinic LLCGroup PAC ID 3779577937, 171 clinicians

Practice addresses (Care Compare)

17495 La Grange Rd
Tinley Park, IL 60487-7581
Phone (708) 226-7000

211 N Eddy St
South Bend, IN 46617-2808
Phone (574) 234-8161

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036.138511ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The South Bend Clinic LLC CurrentSince Jun 1, 2022 Accepting new patients
Radiology & Nuclear Consultants LTD Diagnostic Radiology CurrentSince Jul 27, 2015 Accepting new patients
Dupage Medical Group LTD CurrentSince Sep 29, 2020 Accepting new patients
Dupage Medical Group LTD CurrentSince Sep 29, 2020 Accepting new patients
The South Bend Clinic, LLC CurrentSince Jun 1, 2022 Accepting new patients

Locations

30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210

2320 High St
Blue Island, IL 60406
Phone (708) 226-7000

1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000

1890 Silver Cross Blvd
Ste 345
New Lenox, IL 60451
Phone (815) 462-9300

15300 West Ave
Ste 100
Orland Park, IL 60462
Phone (708) 226-2500

12251 S 80th Ave
Palos Heights, IL 60463
Phone (708) 361-4500

17495 La Grange Rd
Tinley Park, IL 60487
Phone (708) 226-7000

270 W Loop Rd
Wheaton, IL 60189
Phone (630) 653-3284

301 E Day Rd
Mishawaka, IN 46545
Phone (574) 204-7300

211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331

Interoperability endpoints

  • Direct secure messaging: rcenteno212869@direct.edward.org
  • Direct secure messaging: rcenteno212869@dulyhealthandcare.direct-ci.com
  • FHIR API: https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/

Organizations & group practices 5

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": "1239580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1780827337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771260",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17495 LA GRANGE RD",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604877581",
            "telephone_number": "708-226-7000",
            "fax_number": "708-226-7014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CENTENO",
        "first_name": "RACHELLE",
        "middle_name": "CAMAYA",
        "name_prefix": "Mrs.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-13",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036.138511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rcenteno212869@direct.edward.org",
            "affiliation": "N",
            "address_1": "17495 La Grange Rd",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604877581",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rcenteno212869@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "address_1": "17495 La Grange Rd",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604877581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

Verify at the official NPI Registry.