Individual provider Active NPI

Celine Marie Reyes, MS, RD, LDN

  • Registered Dietitian
  • Chicago, IL
National Provider Identifier
1952031064
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
164.008744 Issued in IL
Practice address
845 N Michigan Ave Ste 973W
Chicago, IL 60611-2218
Phone
(312) 651-6255
NPI assigned
Jun 13, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164.008744 IL Primary

Addresses

Primary practice location

845 N Michigan Ave Ste 973W
Chicago, IL 60611-2218

Mailing address

4639 N Broadway St Apt 201
Chicago, IL 60640-5003
Phone (630) 947-4734

Other practice location 1

4639 N Broadway St Apt 201
Chicago, IL 60640-5003
Phone (630) 947-4734

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250723001200 IL Practitioner - Registered Dietitian Or Nutrition Professional 5890201156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Revolution PTWL LLCGroup PAC ID 7719115617, 42 clinicians

Practice addresses (Care Compare)

3418 S Halsted St
Chicago, IL 60608-6708
Phone (773) 337-7627

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
164.008744ILMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Revolution PTWL LLC Dietitian, Registered CurrentSince Jun 1, 2025 Accepting new patients
Mochi Medical Ca PC Past Accepting new patients

Locations

3168 N Broadway St
Chicago, IL 60657
Phone (312) 586-7977

618 W Fulton St
Chicago, IL 60661
Phone (773) 348-7171

4851 N Milwaukee Ave
Chicago, IL 60630
Phone (773) 241-7350

3418 S Halsted St
Chicago, IL 60608
Phone (773) 337-7627

845 N Michigan Ave
Ste 973W
Chicago, IL 60611
Phone (312) 651-6255

205 N Wells St
Chicago, IL 60606
Phone (312) 957-8882

720 Roosevelt Rd
Glen Ellyn, IL 60137
Phone (630) 730-8456

2200 Waukegan Rd
Glenview, IL 60025
Phone (312) 475-1893

28 N Cass Ave
Westmont, IL 60559
Phone (630) 435-1800

Organizations & group practices 2

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": "1655078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1952031064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4639 N BROADWAY ST APT 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405003",
            "telephone_number": "630-947-4734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N MICHIGAN AVE STE 973W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112218",
            "telephone_number": "312-651-6255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4639 N Broadway St Apt 201",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606405003",
            "country_code": "US",
            "telephone_number": "630-947-4734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYES",
        "first_name": "CELINE",
        "middle_name": "MARIE",
        "credential": "MS, RD, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-13",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.008744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.