Individual provider Active NPI

Thomas Joseph Cellini, DO

  • Diagnostic Radiology Physician
  • Chicago, IL
National Provider Identifier
1790212363
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036161203 Issued in IL
Practice address
1653 W Congress Pkwy
Chicago, IL 60612
Phone
(549) 531-2942
NPI assigned
May 15, 2017
Last updated
Sep 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 125071114 IL
Diagnostic Radiology Physician 2085R0202X 036161203 IL Primary

Addresses

Primary practice location

1653 W Congress Pkwy
Chicago, IL 60612

Mailing address

250 E Superior St Ste 4-2304
Chicago, IL 60611-2914
Phone (312) 472-0436

Other practice location 1

836 W Wellington Ave
Chicago, IL 60657-5147
Phone (773) 296-5424

Other practice location 2

836 W Wellington Ave
Chicago, IL 60657-5147
Phone (773) 296-5424

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, MI2 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
I20230814002317 IN Practitioner - Diagnostic Radiology 8729359872 Reassigns benefits to 1 organization
I20230918002484 MI Practitioner - Diagnostic Radiology 8729359872 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Philadelphia College of Osteopathic Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology IncGroup PAC ID 5890695464, 35 clinicians

Practice addresses (Care Compare)

100 Navarre PL
Suite 6655
South Bend, IN 46601-1174
Phone (574) 647-6850

1020 High Rd
Bremen, IN 46506-1093
Phone (574) 546-2211

1115 Professional Dr
Goshen, IN 46526-3800
Phone (574) 364-4850

1135 Professional Dr
Goshen, IN 46526-3800
Phone (574) 364-4000

200 High Park Ave
Goshen, IN 46526-4810
Phone (574) 535-2693

303 S Nappanee St
Elkhart Clinic
Elkhart, IN 46514-2066
Phone (574) 296-3365

600 E Blvd
Elkhart, IN 46514-2483
Phone (574) 294-2621

701 S Health Pkwy
Three Rivers, MI 49093-8352
Phone (269) 278-1145

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036161203ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology, Inc Diagnostic Radiology CurrentSince Aug 1, 2023 Accepting new patients
Beacon Health, LLC Diagnostic Radiology CurrentSince Mar 23, 2026 Accepting new patients
Beacon Health, LLC Diagnostic Radiology CurrentSince Sep 1, 2023 Accepting new patients
Memorial Lighthouse Imaging LLC Diagnostic Radiology Past Accepting new patients

Locations

1020 High Rd
Bremen, IN 46506
Phone (574) 309-9967

1020 High Rd
#O
Bremen, IN 46506
Phone (574) 284-3086

303 S Nappanee St
Elkhart, IN 46514

600 East Blvd
Elkhart, IN 46514
Phone (574) 294-2621

1115 Professional Dr
Goshen, IN 46526
Phone (574) 364-4850

200 High Park Ave
Goshen, IN 46526
Phone (219) 533-2141

2222 Rieth Blvd
Ste 101
Goshen, IN 46526
Phone (574) 875-0881

6901 N Main St
Granger, IN 46530
Phone (574) 647-2900

102 E Culver Rd
Knox, IN 46534
Phone (574) 772-1580

1331 State St
Laporte, IN 46350
Phone (219) 326-2415

620 W Edison Rd
Ste 110
Mishawaka, IN 46545
Phone 5742581100 ext. 239

615 N Michigan St
South Bend, IN 46601
Phone (574) 647-1000

701 S Health Parkway
Three Rivers, MI 49093
Phone (269) 273-9691

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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": "1494806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1790212363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E SUPERIOR ST STE 4-2304",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112914",
            "telephone_number": "312-472-0436",
            "fax_number": "312-472-0480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 W CONGRESS PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "549-531-2942"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "836 W Wellington Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606575147",
            "country_code": "US",
            "telephone_number": "773-296-5424",
            "fax_number": "773-296-5265",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "836 W Wellington Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606575147",
            "country_code": "US",
            "telephone_number": "773-296-5424",
            "fax_number": "773-296-5265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CELLINI",
        "first_name": "THOMAS",
        "middle_name": "JOSEPH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-15",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "125071114",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036161203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.