JENCARE NEIGHBORHOOD MEDICAL CENTER EVERGREEN PARK, LLC (NPI# 1639417496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639417496 |
| Entity Type | Organization |
| Organization Name | JENCARE NEIGHBORHOOD MEDICAL CENTER EVERGREEN PARK, LLC |
| Practice Address |
2734 W 87th St Chicago IL 60652-3937 |
| Mailing Address |
1000 Park Centre Blvd Ste 136 Miami FL 33169-5373 |
| Practice Telephone | 3056286117 |
| Mailing Telephone | 3056286117 |
| Mailing Fax Number | 3056500674 |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2013-01-29 |
| Authorized Official Name | DR. GORDON CHEN (OWNER) |
| Authorized Official Telephone | 3056286117 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332900000X | Non-Pharmacy Dispensing Site | 036.131322 | IL | Suppliers |
| Y | 174400000X | Specialist | 036.131322 | IL | Other Service Providers |
| Street Address |
2734 W 87TH ST |
| City | CHICAGO |
| State | IL |
| Zip Code | 60652-3937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831160944 | Kimberly R Webb | Internal Medicine | 2734 W 87th St, Chicago, IL 60652 | 2006-01-27 |
| 1275816878 | Javeria Javed Syed | Internal Medicine | 2734 W 87th St, Chicago, IL 60652 | 2011-09-21 |
| 1083913255 | Bhavna Balaney | Internal Medicine | 2734 W 87th St, Chicago, IL 60652-3937 | 2011-03-27 |
| 1891938619 | Fahmida Khatoon | Physician Assistant | 2734 W 87th St, Chicago, IL 60652-3937 | 2009-04-09 |
| 1306877329 | Pamela Denise Goodwin-cole | Internal Medicine | 2734 W 87th St, Chicago, IL 60652-3937 | 2006-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861042715 | New Hope Community Service Center | Clinic/Center | New Hope Community Service Center, 2559 West 79th, Chicago, IL 60652 | 2019-09-12 |
| 1770012189 | Rachel Pasternak | Social Worker | 3348 W 87th Street, Chicago, IL 60652 | 2017-06-08 |
| 1437682283 | Manliu Yang | Dentist | 8541 S Cicero Ave, Chicago, IL 60652 | 2017-04-08 |
| 1336687144 | Stephanie J. Wilson | Registered Nurse | 7600 S. Pulask Rd., Chicago, IL 60652 | 2017-02-01 |
| 1346786811 | Talisha Moman | Licensed Practical Nurse | 7600 S. Pulaski Rd., Suite 1106, Chicago, IL 60652 | 2017-01-09 |
| 1952851933 | Yvonne Caldwell | Licensed Practical Nurse | 8600 S. Pulaski, Road, Chicago, IL 60652 | 2016-10-13 |
| 1942605795 | Brittney Mclean | Developmental Therapist | 4317 W. 77th Pl, Chicago, IL 60652 | 2014-10-22 |
| 1245599521 | Chisa Marie Collins | Occupational Therapist | 8008 S Albany, Chicago, IL 60652 | 2012-05-08 |
| 1548572969 | St. Mary Therapy Services | Clinic/Center | 2455 W 79th St, #101, Chicago, IL 60652 | 2010-07-14 |
| 1750574752 | Curt R Lang | Dentist | 4651 W 79th St, Suite 208, Chicago, IL 60652 | 2007-08-22 |
| Find all providers in zip 60652 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346899630 | Jeremy Gantz Morse | Specialist | 815 W Buena Ave, Chicago, IL 60613-1694 | 2019-09-09 |
| 1619539632 | Benjamin Mendoza | Specialist | 6303 W 63rd St Unit 3c, Chicago, IL 60638-7015 | 2019-06-29 |
| 1811471808 | Judith M Penn | Specialist | 8312 S Kedzie Ave, Chicago, IL 60652-3309 | 2018-09-17 |
| 1841774825 | Matthew E Huggins | Specialist | 4553 W 56th St Apt 204c, Chicago, IL 60629-5389 | 2018-09-17 |
| 1750860177 | Muhammad Asim Khan | Specialist | 60 E Delaware Pl, Chicago, Il 60611, 14th Floor Urology- Andrology Clinic, Chicago, IL 60611 | 2018-08-07 |
| 1922502657 | Shauntay Robertson | Specialist | 7342 S Richmond St, Chicago, IL 60629-3015 | 2018-03-19 |
| 1114448644 | Ageless Men's Health Holdings Inc | Specialist | 1729 N Clybourn Ave, Chicago, IL 60614-6503 | 2017-07-06 |
| 1447798871 | Andria Miller | Specialist | 840 N Western Ave, Chicago, IL 60622-4638 | 2017-02-06 |
| 1710425129 | Rtb Sc | Specialist | 5015 N. Paulina #225, Chicago, IL 60640 | 2017-02-06 |
| 1881137354 | Joy Deliverance Williamson | Specialist | 3863 W Flournoy St, Apt. 1w, Chicago, IL 60624-3617 | 2016-11-30 |
| 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.