Organization Active NPI

Med-Peds Specialists S.C.

  • Internal Medicine Physician
  • Orland Park, IL
National Provider Identifier
1790848877
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042618236 Issued in IL
Legal business name
MED-PEDS SPECIALISTS S.C.
Practice address
15614 S Harlem Ave
Suite D
Orland Park, IL 60462-4402
Phone
(708) 444-0097
Fax
(708) 444-8252
NPI assigned
Dec 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

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

Authorized official

Name
Dr. Alicja Kraska, M.D.
Title
Manager
Phone
(708) 444-0097

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 042618236 IL Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

15614 S Harlem Ave
Suite D
Orland Park, IL 60462-4402

Mailing address

15614 S Harlem Ave
Suite D
Orland Park, IL 60462-4402
Phone (708) 444-0097

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060213000763 IL Part B Supplier - Clinic/Group Practice 6608881644 Receives reassigned benefits from 1 practitioner
Practice locations: Orland Park, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1024833Med-Peds Specialists SC15614 S Harlem Ave-Suite D, Orland Park, IL 60462Certificate of waiverApr 21, 2028

National Provider Directory

National Provider Directory

Locations

15614 S Harlem Ave
Ste D
Orland Park, IL 60462
Phone (708) 212-2212

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1790848877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15614 S HARLEM AVE",
            "address_2": "SUITE D",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624402",
            "telephone_number": "708-444-0097",
            "fax_number": "708-444-8252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15614 S HARLEM AVE",
            "address_2": "SUITE D",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624402",
            "telephone_number": "708-444-0097",
            "fax_number": "708-444-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED-PEDS SPECIALISTS S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "KRASKA",
        "authorized_official_first_name": "ALICJA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-444-0097",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "042618236",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.