Dr Elysa Widjaja, MD - Medicare Radiology in Chicago, IL

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Dr Elysa Widjaja, MD is a medicare enrolled "Radiology - Pediatric Radiology" physician in Chicago, Illinois. Her current practice location is Lurie Children's Hospital, 225 E. Chicago Avenue, Chicago, Illinois. You can reach out to her office (for appointments etc.) via phone at (312) 227-3475.

Dr Elysa Widjaja is licensed to practice in Illinois (license number 036.161747) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1184331522.

Contact Information

Dr Elysa Widjaja, MD
Lurie Children's Hospital, 225 E. Chicago Avenue,
Chicago, IL 60611
(312) 227-3475
(312) 227-9783

Map and Direction




Physician's Profile

Full NameDr Elysa Widjaja
GenderFemale
SpecialityRadiology - Pediatric Radiology
LocationLurie Children's Hospital, Chicago, Illinois
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1184331522
  • Provider Enumeration Date: 11/04/2022
  • Last Update Date: 03/06/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 1254701055
  • Enrollment ID: I20230111001683

Medical Identifiers

Medical identifiers for Dr Elysa Widjaja such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1184331522NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2085R0202XRadiology - Diagnostic Radiology 036161747 (Illinois)Secondary
2085P0229XRadiology - Pediatric Radiology 036.161747 (Illinois)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Elysa Widjaja allows following entities to bill medicare on her behalf.
Entity NameNorthwestern Medical Faculty Foundation
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1346235314
PECOS PAC ID: 4587576814
Enrollment ID: O20031105000541
Entity NameLurie Childrens Medical Group Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1992758544
PECOS PAC ID: 0143127761
Enrollment ID: O20031212000692

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Elysa Widjaja is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Elysa Widjaja, MD
Lurie Children's Hospital, 225 E. Chicago Avenue,
Chicago, IL 60611

Ph: (312) 227-3475		Dr Elysa Widjaja, MD
Lurie Children's Hospital, 225 E. Chicago Avenue,
Chicago, IL 60611

Ph: (312) 227-3475

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.