Frederick M Tiesenga, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

36086475 Issued in IL

Practice address

1950 N Harlem Ave
Elmwood Park, IL 60707-3717

Phone

(708) 453-6800

Fax

(708) 453-3235

NPI assigned

Jan 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

General Surgery

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tiesenga Surgical Associates SCGroup PAC ID 5597750901, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community First Medical Center Hospital, Chicago, IL, CCN 140251
• Amita Health Resurrection Medical Center Hospital, Chicago, IL, CCN 140117

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: frederick.tiesenga.1@6699.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/6699/brand/1/csg/1/fhir/r4

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.

• Tiesenga Surgical Associates, S.C.

  • Surgery Physician
  • Elmwood Park, IL
  • NPI 1801876586
  Medicare reassignment Care Compare group NPD
• Medical Associates of Illinois SC

  • Internal Medicine Physician
  • Elmwood Park, IL
  • NPI 1164868618
  NPD (past) Authorized official
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Community First Healthcare of Illinois, Inc

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1033214416
  Care Compare affiliation
• Resurrection Medical Center - Chicago LLC

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1811735228
  Care Compare affiliation

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1801875679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 N HARLEM AVE",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "60707",
            "telephone_number": "708-453-6800",
            "fax_number": "708-453-3985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 N HARLEM AVE",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "607073717",
            "telephone_number": "708-453-6800",
            "fax_number": "708-453-3235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIESENGA",
        "first_name": "FREDERICK",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "36086475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "390720",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36086475",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Len Taing
• Tatiana Ostanina DDS, LTD
• Teresa Dudic
• Gregory D Thurston, DC, DIBCN
• Tiesenga Surgical Associates, S.C.
• Frank A Trocchio, DDS
• Tru Dental Illinois, P.C.
• Trust Medical Transport Inc
• Trust Medical Transport Inc
• Sara Van Trejo

• Surgery Physician in Elmwood Park, IL
• Providers in Elmwood Park, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.