Individual provider Active NPI

Lewis Wasserman

  • Foot Surgery Podiatrist
  • Northbrook, IL
National Provider Identifier
1821284506
Registry record updated Jan 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
016004408 Issued in IL
Practice address
40 Skokie Blvd Ste 520
Northbrook, IL 60062-1601
Phone
(847) 504-5000
Fax
(847) 504-5015
NPI assigned
Sep 17, 2007
Last updated
Jan 22, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X 016004408 IL Primary

Addresses

Primary practice location

40 Skokie Blvd Ste 520
Northbrook, IL 60062-1601

Mailing address

PO Box 917
Northbrook, IL 60065-0917
Phone (847) 504-5000

Other identifiers 3

IdentifierTypeStateIssuer
1821284506MedicaidWI
P01703994OtherWIRAILROAD MEDICARE
P01458509OtherILRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20071228000166 IL Practitioner - Podiatry 3577643832 Reassigns benefits to 1 organization
I20160824001248 WI Practitioner - Podiatry 3577643832 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Preferred Podiatry Group PCGroup PAC ID 3971412677, 131 clinicians

Practice addresses (Care Compare)

1201 N Alton St
Lebanon Care Center
Lebanon, IL 62254-1103
Phone (618) 537-4401

219 E Grace St
Dodgeville, WI 53533-1182
Phone (608) 935-0211

920 Country Club Rd
Mattoon, IL 61938-9201
Phone (217) 235-0001

Merit-based Incentive Payment System (MIPS)

Final score
87.82 of 100Reported as group
Quality
72.99
Improvement activities
40
Cost
75.6

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue7953
Removal or shaving of skin growth4612

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016004408ILMDFoot Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Preferred Podiatry Group PC CurrentSince Feb 22, 2015 Accepting new patients
Xavier W. Parreno, M.D., S.C. Past Accepting new patients
Cosmetic Surgery Specialists PC Past Accepting new patients

Locations

1201 N Alton St
Lebanon, IL 62254
Phone (618) 537-4401

40 Skokie Blvd
Ste 520
Northbrook, IL 60062
Phone (708) 704-6765

8301 Old Sauk Rd
Middleton, WI 53562
Phone (608) 662-8842

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1821284506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600650917",
            "telephone_number": "847-504-5000",
            "fax_number": "847-504-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 SKOKIE BLVD STE 520",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621601",
            "telephone_number": "847-504-5000",
            "fax_number": "847-504-5015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERMAN",
        "first_name": "LEWIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-17",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "IL",
            "license": "016004408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821284506",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01703994",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01458509",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northbrook, IL

Sources for this page

Verify at the official NPI Registry.