Tiesenga Surgical Associates, S.C.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

042000966 Issued in IL

Legal business name

TIESENGA SURGICAL ASSOCIATES, S.C.

Practice address

1950 N Harlem Ave
Elmwood Park, IL 60707

Phone

(708) 453-6800

Fax

(708) 453-3985

NPI assigned

Jan 19, 2006

Organization subpart

No

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

Authorized official

Name

Kathleen Burdett

Title

Administrative Assistant

Phone

(708) 453-6800

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Suburban Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6699/brand/1/csg/1/fhir/r4

Practitioners 8

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

• Christina I Crews, NP

  • Family Nurse Practitioner
  • Elmwood Park, IL
  • NPI 1538467642
  Medicare reassignment Care Compare group NPD
• Deepa Cherla Patel, MD

  • Surgery Physician
  • Elmwood Park, IL
  • NPI 1265876684
  Medicare reassignment Care Compare group NPD
• Matthew David Phillips, MD

  • Surgery Physician
  • Elmwood Park, IL
  • NPI 1962066597
  Medicare reassignment Care Compare group NPD
• Seema Pillai, NP

  • Family Nurse Practitioner
  • Elmwood Park, IL
  • NPI 1013395482
  Medicare reassignment Care Compare group NPD
• Shiny E Saju, FNP

  • Family Nurse Practitioner
  • Elmwood Park, IL
  • NPI 1881125185
  Medicare reassignment Care Compare group NPD
• Timothy Jordan Stear, D.O.

  • Surgery Physician
  • Elmwood Park, IL
  • NPI 1730543984
  Medicare reassignment Care Compare group NPD
• Frederick M Tiesenga, MD

  • Surgery Physician
  • Elmwood Park, IL
  • NPI 1801875679
  Medicare reassignment Care Compare group NPD
• Charles Bradley Schubert, MD

  • Vascular Surgery Physician
  • Elmwood Park, IL
  • NPI 1245219641
  Medicare reassignment NPD

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1801876586",
    "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": "60707",
            "telephone_number": "708-453-6800",
            "fax_number": "708-453-3985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIESENGA SURGICAL ASSOCIATES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "BURDETT",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "708-453-6800"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": "042000966",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "042000966",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0160377350",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PRACTICE",
            "identifier": "950730",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "CI4143",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suburban Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Suburban Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Louis F Taglia, Jr, DDS
• Len Taing
• Tatiana Ostanina DDS, LTD
• Teresa Dudic
• Gregory D Thurston, DC, DIBCN
• Frederick M Tiesenga, MD
• Frank A Trocchio, DDS
• Tru Dental Illinois, P.C.
• Trust Medical Transport Inc
• Trust Medical Transport Inc

• 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 Oct 18, 2022; 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.