Matilda M Rosanwo, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036104686 Issued in IL

Practice address

360 Station Dr
Crystal Lake, IL 60014

Phone

(815) 338-6600

Fax

(815) 455-8044

NPI assigned

Dec 29, 2005

Last updated

Oct 22, 2018By the provider in NPPES

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

Other identifiers 3

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

Specialty

Family Practice

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Lake County Acute Care LLPGroup PAC ID 5395747281, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Medicine McHenry Hospital, McHenry, IL, CCN 140116
• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• Advocate Condell Medical Center Hospital, Libertyville, IL, CCN 140202

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Lake County Acute Care, LLP

  • Family Medicine Physician
  • Gurnee, IL
  • NPI 1861599052
  Medicare reassignment Care Compare group
• Gottlieb Memorial Hospital

  • General Acute Care Hospital
  • Melrose Park, IL
  • NPI 1831170232
  Medicare reassignment NPD
• Gottlieb Memorial Hospital

  • Rehabilitation Hospital Unit
  • Melrose Park, IL
  • NPI 1396109500
  NPD
• Lake County Acute Care, LLP

  • Family Medicine Physician
  • Vernon Hills, IL
  • NPI 1053418244
  NPD
• Lake County Acute Care, LLP

  • Family Medicine Physician
  • Buffalo Grove, IL
  • NPI 1720185911
  NPD
• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• RJM Pathology Consultants LTD

  • Clinical Pathology/Laboratory Medicine Physician
  • Melrose Park, IL
  • NPI 1427061936
  NPD
• Emergency Medical Specialist, S.C

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1265481030
  NPD (past)
• Emergency Medical Specialists, II, S.C.

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1689004863
  NPD (past)
• Extended Care Specialist, LTD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1356365027
  NPD (past)

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

• Advocate Condell Medical Center

  dba Advocate Condell Imaging Center

  • Mobile Mammography Clinic/Center
  • Gurnee, IL
  • NPI 1023262441

  Hospital

  Care Compare affiliation
• Advocate Condell Medical Center

  • General Acute Care Hospital
  • Libertyville, IL
  • NPI 1124272547
  Care Compare affiliation
• Advocate Condell Medical Center

  dba Advocate Condell Medical Center Grays Lake

  • Mobile Mammography Clinic/Center
  • Grayslake, IL
  • NPI 1770737199

  Hospital

  Care Compare affiliation
• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation
• Northern Illinois Medical Center

  dba Centegra Hospital McHenry

  • General Acute Care Hospital
  • McHenry, IL
  • NPI 1982611281
  Care Compare affiliation

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1871570978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 STATION DR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147978",
            "telephone_number": "815-338-6600",
            "fax_number": "815-455-8044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 STATION DR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "815-338-6600",
            "fax_number": "815-455-8044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45 W 111th St",
            "address_2": "Roseland Community Hospital",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606284200",
            "country_code": "US",
            "telephone_number": "773-995-3000",
            "fax_number": "630-734-1560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2507 N Richmond Rd",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600515407",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-385-3255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10350 Haligus Rd",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429545",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "847-802-7112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1925 Huntley Rd",
            "address_purpose": "LOCATION",
            "city": "West Dundee",
            "state": "IL",
            "postal_code": "601189301",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "847-426-5162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSANWO",
        "first_name": "MATILDA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-29",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036104686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0361046863",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036104686",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00424928",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bianca Rollins
• Zitlalli Z Roman Rodriguez, LCSW
• Jorge Roman
• Jennee A Rommel, M.D.
• Margarete A. Ronnett, PSY.D.
• Rosecrance Inc (Rosecrance Crystal Lake)
• Rosecrance Inc (Rosecrance Dakota Clinic)
• Rosecrance, Inc. (Roscrance Crystal Lake)
• Allison Roseland, PT, DPT
• Ria Rosier, PT, DPT

• Family Medicine Physician in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; 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.