Frederic Mark Ettner, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0136053752 Issued in IL

Practice address

7126 N Lincoln Ave
Lincolnwood, IL 60712-2234

Phone

(847) 733-2229

Fax

(847) 733-1528

NPI assigned

Dec 20, 2006

Sex

Male

Sole proprietor

Yes

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Practice

Education

Chicago College of Medicine and Surgery, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
• Swedish Hospital Hospital, Chicago, IL, CCN 140114
• Saint Francis Hospital-Evanston Hospital, Evanston, IL, CCN 140080

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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
• Saint Francis Hospital - Evanston LLC

  • General Acute Care Hospital
  • Evanston, IL
  • NPI 1982442398
  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": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479168000000",
    "number": "1891859468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7126 N LINCOLN AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607122234",
            "telephone_number": "847-733-2229",
            "fax_number": "847-733-1528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7126 N LINCOLN AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607122234",
            "telephone_number": "847-733-2229",
            "fax_number": "847-733-1528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTNER",
        "first_name": "FREDERIC",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2016-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "0136053752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Embassyhrc Inc
• Uzoma B Emeakoroha, PHARMD
• Alvaro Rodrigo Encinas, M.D.
• Daniela Ene, DNP, FNP-C
• Equipe Renal Care of Illinois LLC
• Excel Care Health Services Inc
• Excellent Home Health Physicians Inc.
• Eye on Devon Inc.
• Camille Fabian, OTD
• Family Home Health Care Professionals Inc

• Family Medicine Physician in Lincolnwood, IL
• Providers in Lincolnwood, 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 Nov 15, 2016; 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.