DR. ELYSA WIDJAJA MD
NPI 1184331522
Radiology - Pediatric Radiology in Cincinnati, OH

Q: What is Elysa Widjaja's NPI number?

The NPI number for Elysa Widjaja is 1184331522. It was assigned to this individual provider in the NPPES registry on November 4, 2022.

Q: What is Elysa Widjaja's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Pediatric Radiology, with taxonomy code 2085P0229X.

Q: When was this NPI record last updated?

The NPPES record for Elysa Widjaja was last updated on February 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.

Active since November 04, 2022PECOS Enrolled

3333 BURNET AVE, ML 5031, CINCINNATI, OH 45229(513) 636-4251(513) 636-8145 Get Directions Write a Review

NPPES record last updated: February 12, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 26, 2026, Mar 6, 2023, Nov 14, 2022 and 1 more (4 updates tracked since 2022).

On this page

About Dr. Elysa Widjaja Md NPPES

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

DR. ELYSA WIDJAJA MD (NPI 1184331522) is an individual pediatric radiology provider in Cincinnati, Ohio, licensed in Ohio (35.155182) and active in the NPI registry since November 2022. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (1995).

NPPES Registry Identity

NPI1184331522

Entity TypeIndividualFemale

Primary Taxonomy2085P0229X

Provider Legal NameDR. ELYSA WIDJAJACredential: MD

Location Address3333 BURNET AVE, ML 5031Cincinnati, OH 45229-3026

Mailing Address3333 Burnet Ave, Ml 5031Cincinnati, OH 45229-3026 · (513) 636-4251 · Fax (513) 636-8145

Phone(513) 636-4251

Fax(513) 636-8145

Sole ProprietorYes

Medical School CMSOtherGraduated 1995

Enumeration DateNovember 4, 2022

Last NPPES UpdateFebruary 12, 20264 updates tracked since enumeration

NPPES CertifiedFebruary 12, 2026

✔ NPI 1184331522 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyRadiology · Pediatric RadiologyAllopathic & Osteopathic Physicians

Taxonomy Code2085P0229X

Licenses✔ Licensed in OH · 35.155182✔ Licensed in IL · 036.161747

Definition

A radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child and adolescent. This specialist has knowledge of both imaging and interventional procedures related to the care and management of diseases of children. A pediatric radiologist must be highly knowledgeable of all organ systems as they relate to growth and development, congenital malformations, diseases peculiar to infants and children and diseases that begin in childhood but cause substantial residual impairment in adulthood.

Also ListedRadiology · Diagnostic RadiologyTaxonomy 2085R0202X · License 036161747 (IL)

3333 BURNET AVE, Cincinnati, OH 45229

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Secondary Practice Locations 2

Location 1Lurie Children's Hospital, 225 E. Chicago AvenueChicago, IL 60611 · Phone (312) 227-3475 · Fax (312) 227-9783

Location 2676 N Saint Clair St Ste 800Chicago, IL 60611-2978 · Phone (312) 695-5753 · Fax (312) 695-5645

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Elysa Widjaja Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1254701055

PECOS Enrollment IDI20260305004065

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 Reassignment

Medicare enrollment records show Elysa Widjaja reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Children's Hospital Medical Center

Same address

Pediatrics

3333 BURNET AVENUE
Cincinnati, OH 45229

Reassigned Medicare billing, Ohio enrollment
2,080 clinicians in this Medicare group

NPI 1609915784 (513) 636-4225

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

Other Providers at the Same Location NPPES 20

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

PREEYACHA PACHARN M.D.

Radiology (Pediatric Radiology)

3333 BURNET AVE, ML 5031
CINCINNATI, OH 45229

Hamilton County (513) 636-4251

BRIAN KEITH TURPIN D.O.

Pediatrics (Pediatric Hematology-Oncology)

3333 BURNET AVE
CINCINNATI, OH 45229

Hamilton County (513) 636-3381

ETHAN J MUSGRAVE M.D.

Psychiatry & Neurology (Child & Adolescent Psychiatry)

3333 BURNET AVE, ML 3014
CINCINNATI, OH 45229

Hamilton County (513) 636-4788

KATHRYN WEAVER M.D.

Medical Genetics (Clinical Genetics (M.D.))

3333 BURNET AVE, ML 4006
CINCINNATI, OH 45229

Hamilton County (513) 636-4760

ROBIN T COTTON, MD, INC

Otolaryngology (Pediatric Otolaryngology)

3333 BURNET AVE, MLC 2018
CINCINNATI, OH 45229

Hamilton County (513) 636-7138

ELIZABETH ANN MOORE CNP

Nurse Practitioner (Acute Care)

3333 BURNET AVE, ML 2003
CINCINNATI, OH 45229

Hamilton County (513) 636-4432

CONSTANCE MARIE MARTIN CNP

Nurse Practitioner (Primary Care)

3333 BURNET AVE, ML 2018
CINCINNATI, OH 45229

Hamilton County (513) 636-4355

EMILY RENAE LY LSW

Case Manager/Care Coordinator

3333 BURNET AVE
CINCINNATI, OH 45229

Hamilton County (513) 803-6316

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 Elysa Widjaja's NPI number?

The NPI number for Elysa Widjaja is 1184331522. It was assigned to this individual provider in the NPPES registry on November 4, 2022.

Where is Elysa Widjaja located?

Elysa Widjaja practices at 3333 Burnet Ave Ml 5031, Cincinnati, OH 45229. The listed phone number is (513) 636-4251.

What is Elysa Widjaja's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Pediatric Radiology, with taxonomy code 2085P0229X.

Is Elysa Widjaja enrolled in Medicare?

Yes. Elysa Widjaja is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Elysa Widjaja's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Elysa Widjaja reassigns Medicare benefits to Children's Hospital Medical Center (Cincinnati, OH). The 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 Elysa Widjaja's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Elysa Widjaja accept?

Health plans from CareSource list Elysa Widjaja 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 Elysa Widjaja was last updated on February 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.