Eduardo J Cisneros

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209034192 Issued in IL

Practice address

5 Revere Dr Ste 200
Northbrook, IL 60062-8000

Phone

(312) 600-3991

Fax

(630) 473-2232

NPI assigned

Jul 17, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bespoke PsychiatryGroup PAC ID 3274951744, 51 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bespoke Psychiatry

  • Psychiatry Physician
  • Chicago, IL
  • NPI 1952937104
  Medicare reassignment Care Compare group NPD
• The Ruth Institute of Integrative Care LLC

  • Psychiatry Physician
  • Northbrook, IL
  • NPI 1538745153
  Medicare reassignment NPD

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

{
    "created_epoch": "1752710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767139200000",
    "number": "1861384513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4824 N TRIPP AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302721",
            "telephone_number": "312-320-1971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 REVERE DR STE 200",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600628000",
            "telephone_number": "312-600-3991",
            "fax_number": "630-473-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CISNEROS",
        "first_name": "EDUARDO",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-17",
        "last_updated": "2025-12-31",
        "certification_date": "2025-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209034192",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "IL",
            "license": "041524344",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phillip Yunmogee Chung, MD
• Evan Chwa, DMD
• Kyint Hwat Chwa, BDS DDS MS
• Scott B. Cienkus, MD
• Ana Cintron
• Citadel of Northbrook LLC
• Aura Ciungan
• John Steven Clark II
• Claudia Welke MD LLC
• Domingo J Claudio Jr.

• Psychiatric/Mental Health Nurse Practitioner in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2025; 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.