Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Timothy Raymond Niedzielak, DO

Individual provider Orthopaedic Surgery Physician · NPI 1972028421

Dr. Timothy Raymond Niedzielak, DO is an Orthopedic Surgery in Rockford, Illinois. Qualified in 2017, 9 years ago. Practices with Acute Care Surgery of South Dakota PC, a 68-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida, Illinois and Missouri.

Years since qualifying
9
Licensed in
FL, IL, MO
In the registry since
2017
Specialties on file
5
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

8201 E Riverside Blvd
Rockford, IL 61114-2300
Phone: (815) 971-7000
Fax: (815) 968-7830
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1100 Virginia Ave, Columbia, MO 65212-0001 — (573) 882-2663

Specialties & licences

Orthopaedic Surgery Physician (primary) Taxonomy 207X00000X · Licence 036165587 (IL)
Orthopaedic Surgery Physician Taxonomy 207X00000X · Licence 5665 (FL)
Orthopaedic Surgery Physician Taxonomy 207X00000X · Licence 2022018519 (MO)
Orthopaedic Trauma Physician Taxonomy 207XX0801X · Licence 2022018519 (MO)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence 5665 (FL)

Record details

NPI number1972028421
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedAugust 6, 2017
Last updated in NPPESSeptember 12, 2023
Certification dateSeptember 12, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyORTHOPEDIC SURGERY
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Acute Care Surgery Of South Dakota Pc — 68 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Rockford