Individual provider Active NPI

Andrew Tannenbaum, M.D.

  • Vascular & Interventional Radiology Physician
  • Harvard, IL
National Provider Identifier
1972867315
Registry record updated Apr 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
036147111 Issued in IL
Practice address
901 Grant St
Harvard, IL 60033-1821
Phone
(815) 943-5431
Fax
(815) 943-0659
NPI assigned
Jun 29, 2012
Last updated
Apr 1, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 252241 MA
Diagnostic Radiology Physician 2085R0202X 252241 MA
Vascular & Interventional Radiology Physician 2085R0204X 036147111 IL Primary

Addresses

Primary practice location

901 Grant St
Harvard, IL 60033-1821

Mailing address

901 Grant St
Harvard, IL 60033-1821
Phone (815) 943-5431

Other practice location 1

1 Boston Medical Ctr Pl
Dept of Radiology - FGH Bldg
Boston, MA 02118-2908
Phone (617) 638-8000

Other practice location 2

1045 W Stephenson St
Freeport, IL 61032-4864
Phone (815) 599-6000

Other practice location 3

1045 W Stephenson St
Freeport, IL 61032-4864
Phone (815) 599-6000

Other practice location 4

8201 E Riverside Blvd
Rockford, IL 61114-2300
Phone (815) 971-5000

Other practice location 5

875 South Route 31
Crystal Lake, IL 60014
Phone (779) 220-5500

Other practice location 6

2000 Lake Ave
Woodstock, IL 60098-7401
Phone (815) 337-7100

Other practice location 7

3922 Mercy Dr
McHenry, IL 60050-3179
Phone (815) 344-4499

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
I20181017001453 IL Practitioner - Diagnostic Radiology 4981836897 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Boston University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rockford Health PhysiciansGroup PAC ID 2567374036, 520 clinicians
Mercy Health System CorporationGroup PAC ID 7416860440, 749 clinicians

Practice addresses (Care Compare)

2400 N Rockton Ave
Rockford, IL 61103-3655
Phone (815) 971-5000

901 Grant St
Harvard, IL 60033-1821
Phone (815) 943-5431

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal14
Leg revascularization (restoring blood flow)11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
252241MAMDDiagnostic Radiology Physician
036147111ILMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Health Physicians CurrentSince May 25, 2019 Accepting new patients
RMH Pathologists, LTD Current Accepting new patients
Singleton Associates PA Diagnostic Radiology CurrentSince Feb 1, 2026 Accepting new patients
Mercy Health System Corporation CurrentSince Feb 28, 2020 Accepting new patients
Mercy Health System Corporation CurrentSince Feb 28, 2020 Accepting new patients
Specialists in Medical Imaging SC Diagnostic Radiology CurrentSince Feb 1, 2019 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

875 S State Route 31
Crystal Lake, IL 60014
Phone (779) 220-5500

348 S Division St
Harvard, IL 60033
Phone (815) 943-1122

901 Grant St
Harvard, IL 60033
Phone (815) 943-2961

3922 Mercy Dr
McHenry, IL 60050
Phone (815) 344-4499

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

8201 E Riverside Blvd
Rockford, IL 61114
Phone (815) 971-4066

2000 Lake Ave
Woodstock, IL 60098
Phone (815) 337-4116

Interoperability endpoints

  • Direct secure messaging: atannenbaum63286@direct.mhemail.org

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775001600000",
    "number": "1972867315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 GRANT ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600331821",
            "telephone_number": "815-943-5431",
            "fax_number": "815-943-0659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 GRANT ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600331821",
            "telephone_number": "815-943-5431",
            "fax_number": "815-943-0659"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Boston Medical Ctr Pl",
            "address_2": "Dept of Radiology - FGH Bldg",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021182908",
            "country_code": "US",
            "telephone_number": "617-638-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1045 W Stephenson St",
            "address_purpose": "LOCATION",
            "city": "Freeport",
            "state": "IL",
            "postal_code": "610324864",
            "country_code": "US",
            "telephone_number": "815-599-6000",
            "fax_number": "815-599-7974",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1045 W Stephenson St",
            "address_purpose": "LOCATION",
            "city": "Freeport",
            "state": "IL",
            "postal_code": "610324864",
            "country_code": "US",
            "telephone_number": "815-599-6000",
            "fax_number": "815-599-7974",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8201 E Riverside Blvd",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611142300",
            "country_code": "US",
            "telephone_number": "815-971-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "875 South Route 31",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "60014",
            "country_code": "US",
            "telephone_number": "779-220-5500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Lake Ave",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "IL",
            "postal_code": "600987401",
            "country_code": "US",
            "telephone_number": "815-337-7100",
            "fax_number": "815-337-4793",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3922 Mercy Dr",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600503179",
            "country_code": "US",
            "telephone_number": "815-344-4499",
            "fax_number": "815-344-4779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANNENBAUM",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-29",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "252241",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "252241",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IL",
            "license": "036147111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harvard, IL

Sources for this page

Verify at the official NPI Registry.