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MARCIA RADJA APN
NPI 1164776670
Nurse Practitioner - Family in Downers Grove, IL

Active since November 06, 2012PECOS EnrolledAccepts Medicare Assignment
516 GRANT ST, DOWNERS GROVE, IL 60515(630) 413-1303(888) 311-3015 Get Directions Write a Review

NPPES record last updated: September 26, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Marcia Radja Apn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARCIA RADJA APN (NPI 1164776670) is an individual family provider in Downers Grove, Illinois, licensed in Illinois (209009942) and active in the NPI registry since November 2012. She is enrolled in Medicare PECOS and is a graduate of Other (2012).

NPPES Registry Identity

NPI1164776670
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMARCIA RADJACredential: APN
Location Address516 GRANT STDowners Grove, IL 60515-3024
Mailing Address516 Grant StDowners Grove, IL 60515-3024 · (630) 413-1303 · Fax (888) 311-3015
Phone(630) 413-1303
Fax(888) 311-3015
Sole ProprietorNo
Medical School CMSOtherGraduated 2012
Enumeration DateNovember 6, 2012
Last NPPES UpdateSeptember 26, 2025
NPPES CertifiedSeptember 26, 2025
✔ NPI 1164776670 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IL · 209009942
516 GRANT ST, Downers Grove, IL 60515
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Marcia Radja Apn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9335389113
PECOS Enrollment IDI20130628000530
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

9

Medicare enrollment records show Marcia Radja reassigns Medicare billing to 9 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Pentom Health Services LLC
Same address
Family
516 GRANT ST
Downers Grove, IL 60515
  • Reassigned Medicare billing, Illinois enrollment
NPI 1366125536 (630) 413-1303
Advocate Health And Hospitals Corporation
1.0 mi
Cardiovascular Disease
3825 HIGHLAND AVE, TOWER 2 SUITE 400
Downers Grove, IL 60515
  • Reassigned Medicare billing, Illinois enrollment
  • 4,870 clinicians in this Medicare group
NPI 1285903849 (630) 719-4799
Prospect Healthcare Sc
3.1 mi
Family Medicine
2 E 22ND ST, SUITE 110
Lombard, IL 60148
  • Reassigned Medicare billing, Illinois enrollment
  • 4 clinicians in this Medicare group
NPI 1194044743 (630) 376-6317
Community Home Physicians, LLC
3.4 mi
Physical Medicine & Rehabilitation
1S450 SUMMIT AVE STE 165
Oakbrook Terrace, IL 60181
  • Reassigned Medicare billing, Illinois enrollment
  • 97 clinicians in this Medicare group
NPI 1568909505 (630) 320-6871
Vital Signs Wellness, LLC
17 mi
Family Medicine
744 LESLIE LANE
Schaumburg, IL 60194
  • Reassigned Medicare billing, Illinois enrollment
  • 7 clinicians in this Medicare group
NPI 1528538600 (855) 293-1448
Eaves Health Partners PLLC
21 mi
Clinical
5151 CHURCH ST
Skokie, IL 60077
  • Reassigned Medicare billing, Illinois enrollment
  • 44 clinicians in this Medicare group
NPI 1639847551 (847) 933-9200
Chestnut Health Of Illinois LLC
25 mi
Internal Medicine
1530 N RANDALL RD, SUITE 200
Elgin, IL 60123
  • Reassigned Medicare billing, Illinois enrollment
  • 66 clinicians in this Medicare group
NPI 1588043939 (224) 760-7322
Frontier Healthcare Systems Of Illinois LLC
25 mi
Family
20280 GOVERNORS HWY STE 102
Olympia Fields, IL 60461
  • Reassigned Medicare billing, Illinois enrollment
  • 8 clinicians in this Medicare group
NPI 1053772020 (708) 234-0388
Care Connect Of Illinois Providers PLLC
108 mi
Internal Medicine
519 ELLIOTT ST STE S1
Kewanee, IL 61443
  • Reassigned Medicare billing, Illinois enrollment
  • 2 clinicians in this Medicare group
NPI 1790620995 (309) 525-0703

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
491 services74 patients
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month 99490
Chronic care management services involve a healthcare professional directing clinical staff in managing your chronic conditions. This includes the first 20 minutes per month of services like medication management, care coordination, and health monitoring to help improve your health and quality of life.
296 services69 patients
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309
A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
166 services62 patients
Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes 99349
An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.
72 services24 patients
Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more 99306
An initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.
51 services50 patients
Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes 99310
A follow-up nursing facility visit is a routine check-up that typically lasts about 35 minutes. During this visit, your health status is evaluated, any changes in your condition are noted, and necessary adjustments to your care plan are made. It's an essential part of maintaining your health.
36 services27 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60515 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$93.02 typical visit price
range $59.81 – $181.38
Typical copayment $23.25 (range $14.95 – $45.34)
Most-billed visit code 99203
Established Patient
$105.07 typical visit price
range $19.15 – $147.12
Typical copayment $26.26 (range $4.78 – $36.78)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 5

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
1 supplier12 claims12 services$14.44 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
2 suppliers18 claims18 services$65.02 avg. paid by Medicare
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg J7613
DME-Drugs Administered Through DME · category DG006N
2 suppliers13 claims2,270 services$0.03 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
2 suppliers18 claims18 services$214.97 avg. paid by Medicare
Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513
DME-Other DME · category DE000N
2 suppliers14 claims14 services$20.46 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PENTOM HEALTH SERVICES LLC
Nurse Practitioner (Family)
516 GRANT ST
DOWNERS GROVE, IL 60515
Dupage County (630) 413-1303

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Marcia Radja's NPI number?

The NPI number for Marcia Radja is 1164776670. It was assigned to this individual provider in the NPPES registry on November 6, 2012.

Where is Marcia Radja located?

Marcia Radja practices at 516 Grant St, Downers Grove, IL 60515. The listed phone number is (630) 413-1303.

What is Marcia Radja's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Marcia Radja enrolled in Medicare?

Yes. Marcia Radja is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Marcia Radja's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Marcia Radja reassigns Medicare benefits to 9 organizations: Pentom Health Services LLC (Downers Grove, IL), Advocate Health And Hospitals Corporation (Downers Grove, IL), Prospect Healthcare Sc (Lombard, IL), Community Home Physicians, LLC (Oakbrook Terrace, IL), Vital Signs Wellness, LLC (Schaumburg, IL) and 4 more organizations, listed in the Medicare section above. Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Marcia Radja's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Marcia Radja accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Marcia Radja as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Marcia Radja was last updated on September 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.