CENTEGRA PRIMARY CARE LLC (NPI# 1568904597) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568904597 |
| Entity Type | Organization |
| Organization Name | CENTEGRA PRIMARY CARE LLC |
| Other Organization Name | CENTEGRA PHYSICIAN CARE MCHENRY COUNTY ORTHOPEDIC |
| Practice Address |
10370 Haligus Rd Suite 201 Huntley IL 60142 |
| Practice Telephone | 8153565200 |
| Practice Fax Number | 8153565262 |
| Mailing Telephone | 8153565200 |
| Mailing Fax Number | 8153565262 |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2017-05-10 |
| Authorized Official Name | DAVID TOMLINSON (CIO & CFO) |
| Authorized Official Telephone | 8157885831 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| CENTEGRA PHYSICIAN CARE MCHENRY COUNTY ORTHOPEDIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962832873 | Centegra Primary Care LLC | Chiropractor | 2507 North Richmond Road, Mchenry, IL 60050 | 2013-11-14 |
| 1356883599 | Centegra Primary Care LLC | Family Medicine | 420 N Il Route 31, Crystal Lake, IL 60012-3709 | 2016-11-04 |
| Street Address |
10370 HALIGUS RD SUITE 201 |
| City | HUNTLEY |
| State | IL |
| Zip Code | 60142 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164022901 | American Drug Stores LLC | Durable Medical Equipment & Medical Supplies | 10090 Route 47, Huntley, IL 60142 | 2020-10-30 |
| 1881201895 | Activefit Physical Therapy and Personal Training | Physical Therapist | 12172 S. Route 47, #125, Huntley, IL 60142 | 2020-09-24 |
| 1710512801 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 9940 Rt 47, Huntley, IL 60142 | 2020-03-09 |
| 1427689744 | Gilberts Evolve LLC | Chiropractor | 9738 Illinois Hwy 47, Huntley, IL 60142 | 2020-01-27 |
| 1790332898 | Mary Casper | Technician | 12829 Mesa St, Huntley, IL 60142 | 2019-08-22 |
| 1437719838 | Faith A Furst | Student in an Organized Health Care Education/Training Program | 12300 Il-47, Huntley, IL 60142 | 2019-06-18 |
| 1578046934 | Shelby Osterberg | Physical Therapist | 12112 S Rt 47, Huntley, IL 60142 | 2018-09-12 |
| 1801378229 | Emilyn Pollack | Nurse Practitioner | 9850 Grimley, Huntley, IL 60142 | 2018-09-01 |
| 1215452537 | Jennifer Amanda Baudin | Occupational Therapy Assistant | 10580 Oakland Ct, Huntley, IL 60142 | 2017-08-08 |
| 1902336555 | Tyler J Wylde | Dentist | 12222 Il-47, Huntley, IL 60142 | 2017-06-15 |
| Find all providers in zip 60142 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689093544 | Alicia Marie Waite | Family Medicine | 13900 Quality Drive, Huntley, IL 60142 | 2014-04-08 |
| 1255567574 | Michelle Dianne Willis | Family Medicine | 12151 Regency Pkwy Ste 155, Huntley, IL 60142-7644 | 2009-06-01 |
| 1417122813 | Jerome Robert Walker | Family Medicine | 12432 Pheasant Ridge Dr, Huntley, IL 60142-7465 | 2008-04-25 |
| 1497816268 | Amrit R Singh | Family Medicine | 12179 Regency Pkwy, Vitas Healthcare and Hospice, Huntley, IL 60142-7644 | 2006-12-13 |
| 1568579571 | Ramon A Gonzalez | Family Medicine | 12525 Regency Pkwy, Suite F, Huntley, IL 60142-6500 | 2006-08-24 |
| 1194006742 | Pooja Srinivas Dewilde | Family Medicine | 10350 Haligus Rd Ste 200, Huntley, IL 60142 | 2011-09-08 |
| 1073620175 | Anita N Szeto | Family Medicine | 10350 Haligus Rd Ste 200, Huntley, IL 60142 | 2006-08-24 |
| 1255350666 | Rodrigo Bastidas | Family Medicine | 10350 Haligus Rd Ste 200, Huntley, IL 60142 | 2006-07-18 |
| 1376583658 | Marietta P Abraham | Family Medicine | 10350 Haligus Rd, Huntley, IL 60142-9545 | 2006-06-07 |
| 1669430567 | Fazal Khan | Family Medicine | 10350 Haligus Rd, Huntley, IL 60142-9558 | 2006-05-02 |
| Find all providers in HUNTLEY | ||||
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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.