Individual provider Active NPI

Ellen Swiontknowski Wagner, MD

  • Pediatric Gastroenterology Physician
  • Chicago, IL
National Provider Identifier
1871089136
Registry record updated Aug 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
036155898 Issued in IL
Practice address
225 E Chicago Ave
Chicago, IL 60611-2991
Phone
(800) 543-7362
NPI assigned
Jul 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 036155898 IL Primary

Addresses

Primary practice location

225 E Chicago Ave
Chicago, IL 60611-2991

Mailing address

225 E Chicago Ave
Chicago, IL 60611-2991
Phone (800) 543-7362

Other practice location 1

2515 N Clark St
Chicago, IL 60614-2730
Phone (800) 543-7362

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
I20180801000712 IL Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 8527316900

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Pediatric Medicine
Education
Loyola University of Chicago, Stritch School of Medicine, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

225 E Chicago Ave
Chicago, IL 60611-2991

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lurie Children'S Medical Group, LLC Pediatrics Past Accepting new patients

Organizations & group practices 1

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": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785715200000",
    "number": "1871089136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "800-543-7362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "800-543-7362"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2515 N Clark St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606142730",
            "country_code": "US",
            "telephone_number": "800-543-7362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELLEN",
        "middle_name": "SWIONTKNOWSKI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-10",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "IL",
            "license": "036155898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.