Individual provider Active NPI

Gary Lee Reschak, M.D.

  • Pediatrics Physician
  • Crystal Lake, IL
National Provider Identifier
1811218654
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036151382 Issued in IL
Practice address
650 Dakota St Ste a
Crystal Lake, IL 60012-3744
Phone
(815) 455-6000
Fax
(815) 356-1104
NPI assigned
Jun 16, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 40881 IA
Pediatrics Physician 208000000X 036151382 IL Primary

Addresses

Primary practice location

650 Dakota St Ste a
Crystal Lake, IL 60012-3744

Mailing address

650 Dakota St Ste a
Crystal Lake, IL 60012-3744
Phone (815) 455-6000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200203000970 IL Practitioner - Pediatric Medicine 5698918167 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036151382ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Jan 20, 2020 Accepting new patients
Central Dupage Physician Group Pediatrics CurrentSince Jan 20, 2020 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

650 Dakota St
Crystal Lake, IL 60012
Phone (815) 455-6000

650 Dakota St
Ste A
Crystal Lake, IL 60012
Phone (815) 334-5018

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 2

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": "1276646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1811218654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 DAKOTA ST STE A",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123744",
            "telephone_number": "815-455-6000",
            "fax_number": "815-356-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 DAKOTA ST STE A",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123744",
            "telephone_number": "815-455-6000",
            "fax_number": "815-356-1104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RESCHAK",
        "first_name": "GARY",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-16",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "40881",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036151382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.