Mariola Kaczkowski

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209008582 Issued in IL

Practice address

1875 Dempster St
Suite 180
Park Ridge, IL 60068-1186

Phone

(847) 825-0800

NPI assigned

Jan 6, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Kirill Zhadovich, M.D., S.C.Group PAC ID 3072545896, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
• Northwest Community Hospital 1 Hospital, Arlington Heights, IL, CCN 140252
• Swedish Hospital Hospital, Chicago, IL, CCN 140114

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  Medicare reassignment Care Compare group
• Kirill Zhadovich, M.D., S.C.

  • Primary Care Clinic/Center
  • Niles, IL
  • NPI 1659556546
  Medicare reassignment Care Compare group

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

• Endeavor Health Clinical Operations

  • General Acute Care Hospital
  • Evanston, IL
  • NPI 1184670549
  Care Compare affiliation
• Northwest Community Hospital

  • General Acute Care Hospital
  • Arlington Heights, IL
  • NPI 1578932869
  Care Compare affiliation
• Northwest Community Hospital

  • General Acute Care Hospital
  • Arlington Heights, IL
  • NPI 1770531600
  Care Compare affiliation
• Swedish Covenant Health

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1831151257
  Care Compare affiliation

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294272000000",
    "number": "1861796724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2056",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600652056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 DEMPSTER ST",
            "address_2": "SUITE 180",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681186",
            "telephone_number": "847-825-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACZKOWSKI",
        "first_name": "MARIOLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-06",
        "last_updated": "2011-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209008582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Cain Therapy Services PLLC
• David Youngsik Jun, MD
• Tomasz Jurczak, LPC
• Oleksandr Kachanov, M.D.
• Shawn Ashley Kacker, DO
• Neha Sangeeta Kadambi
• Charles Edward Kaegi Jr., MD
• Amir F Kagalwalla, MD
• Pamela E Kaiser, M.D.
• George Kalapurakal, DO

• Nurse Practitioner in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; 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.