CENTRAL ADDISON MEDICAL GROUP LLC (NPI# 1316006422) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316006422 |
| Entity Type | Organization |
| Organization Name | CENTRAL ADDISON MEDICAL GROUP LLC |
| Practice Address |
5645 W Addison St Chicago IL 60634-4403 |
| Mailing Address |
9460 Irving Park Rd Po Box 2245 Schiller Park IL 60176-1959 |
| Practice Telephone | 8476859326 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. DAVID FISHMAN (PRINCIPAL PARTNER) |
| Authorized Official Telephone | 8476859326 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Street Address |
5645 W ADDISON ST |
| City | CHICAGO |
| State | IL |
| Zip Code | 60634-4403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306845763 | Our Lady of The Resurrection Medical Center | Emergency Medicine | 5645 W Addison St, Chicago, IL 60634-4403 | 2005-07-19 |
| 1740809797 | Nicholas Donald Charmelo | Registered Nurse | 5645 W Addison St, Chicago, IL 60634-2881 | 2020-04-09 |
| 1528695814 | Ana Bulaja | Physician Assistant | 5645 W Addison St, Chicago, IL 60634-2881 | 2020-03-25 |
| 1669008702 | Jeremy Blauser | Physician Assistant | 5645 W Addison St, Chicago, IL 60634-4403 | 2020-03-20 |
| 1598306870 | Sss Pathology Services Pllc | Pathology | 5645 W Addison St, Chicago, IL 60634-4403 | 2019-10-08 |
| 1639737851 | Akhter U Patel | Nurse Practitioner | 5645 W Addison St, Chicago, IL 60634-4403 | 2019-06-03 |
| 1457916124 | Jaclyn Novak | Physician Assistant | 5645 W Addison St, Chicago, IL 60634-4403 | 2019-05-07 |
| 1962977421 | Ashley Fisher | Dietitian, Registered | 5645 W Addison St, Chicago, IL 60634-4403 | 2018-10-10 |
| 1093211153 | Brandee Joy Grenda | Dietitian, Registered | 5645 W Addison St, Chicago, IL 60634-4403 | 2018-04-05 |
| 1639687825 | Amy M Boettcher | Nurse Anesthetist, Certified Registered | 5645 W Addison St, Chicago, IL 60634-4403 | 2018-01-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356987333 | Alejandra Carrera | Student in an Organized Health Care Education/Training Program | 6417 W Irving Park Rd., Chicago, IL 60634 | 2019-11-25 |
| 1861977456 | Virtue Counseling Center | Counselor | 2904 N Parkside, Chicago, IL 60634 | 2018-09-28 |
| 1770931255 | Dynamic Transport Solutions LLC | Non-emergency Medical Transport (VAN) | 6109 W. Barry, Chicago, IL 60634 | 2016-05-25 |
| 1104284710 | Ez Dental | Dental Laboratory | 5621 W.montrose Avenue, Chicago, IL 60634 | 2016-02-10 |
| 1285075432 | Chicago Medical Transportation | Non-emergency Medical Transport (VAN) | 3033 N. Nordica Ave., Chicago, IL 60634 | 2013-07-16 |
| 1083985725 | Maria C. Rodriguez | Lactation Consultant, Non-RN | 6216 W. School St., Chicago, IL 60634 | 2012-01-25 |
| 1295066827 | Angie Harris | Occupational Therapist | 3339 N. Octavia, Chicago, IL 60634 | 2010-01-21 |
| 1205169802 | Belmont Dental P.C. | Dentist | 5611 W. Belmont Ave., Chicago, IL 60634 | 2009-09-14 |
| 1568605178 | Henry Biskup | Radiologic Technologist | 3105 N. Austin Ave., Chicago, IL 60634 | 2009-04-13 |
| 1306086624 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 3615 N. Central Ave, Chicago, IL 60634 | 2009-02-26 |
| Find all providers in zip 60634 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427457399 | Charles Joseph Frahm | Internal Medicine | 1200 E Madison Park, Chicago, IL 60615-2961 | 2014-08-17 |
| 1225447725 | Jeremy R. Estrada | Internal Medicine | 5841 S Maryland Ave # Mc5841, Chicago, IL 60637-1447 | 2014-08-08 |
| 1285049197 | Nidhi Madan | Internal Medicine | 1717 W Congress Pkwy Ste 317, Chicago, IL 60612 | 2014-06-30 |
| 1588097596 | Atif Khawaja Hassan | Internal Medicine | 5140 N California Ave Ste 740, Chicago, IL 60625-7066 | 2013-08-13 |
| 1952651382 | Rajeev Ruben Fernando | Internal Medicine | 365 N Jefferson St, 2712, Chicago, IL 60661-1226 | 2012-09-13 |
| 1174888945 | Mohammad Tarek Kabbany | Internal Medicine | 676 N Saint Clair St Ste 7-730, Chicago, IL 60611-2927 | 2012-07-09 |
| 1740589175 | United Diagnostic Services, LLC | Internal Medicine | 6124 N Milwaukee Ave Ste 2, Chicago, IL 60646-3820 | 2011-03-24 |
| 1932361433 | Sanjay S Gill | Internal Medicine | 2266 N. Lincoln Ave., 3, Chicago, IL 60614 | 2008-06-26 |
| 1053571208 | Curewell Diagnostic Services LLC | Internal Medicine | 6124 N Milwaukee Ave Ste 1, Chicago, IL 60646-3820 | 2008-06-11 |
| 1972760718 | Steve Attanasio | Internal Medicine | 1725 W Harrison St Ste 1159, Chicago, IL 60612 | 2008-05-20 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.