PROVIDA HEALTH CENTER SC (NPI# 1881890333) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881890333 |
| Entity Type | Organization |
| Organization Name | PROVIDA HEALTH CENTER SC |
| Practice Address |
1425 N Hunt Club Rd Ste 100 Gurnee IL 60031 |
| Mailing Address |
1425 N Hunt Club Rd Ste 100 Gurnee IL 60031-2632 |
| Practice Telephone | 8475482200 |
| Practice Fax Number | 8475482865 |
| Mailing Telephone | 8475482200 |
| Mailing Fax Number | 8475482865 |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2018-06-26 |
| Authorized Official Name | LUIS I SALAZAR (PRESIDENT) |
| Authorized Official Telephone | 8475482200 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 042616958 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS NUMBER | 04923018 | 01 |
| IL | CORPORATE IL LICENSE | 042616958 | 01 |
| Street Address |
1425 N HUNT CLUB RD STE 100 |
| City | GURNEE |
| State | IL |
| Zip Code | 60031 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417942822 | Luis I Salazar | Family Medicine | 1425 N Hunt Club Rd Ste 100, Gurnee, IL 60031-2632 | 2005-09-13 |
| 1700442084 | Dominic Alesandrini | Physician Assistant | 1425 N Hunt Club Rd Ste 100, Gurnee, IL 60031 | 2019-05-13 |
| 1033773288 | Megan Gregory Kahue | Physician Assistant | 1425 N Hunt Club Rd Ste 100, Gurnee, IL 60031-2632 | 2019-04-23 |
| 1821404336 | Caitlin M Chandran | Nurse Practitioner | 1425 N Hunt Club Rd Ste 100, Gurnee, IL 60031 | 2014-07-03 |
| 1952733818 | Ksenia Samvel | Physician Assistant | 1425 N Hunt Club Rd Ste 100, Gurnee, IL 60031-2632 | 2013-08-02 |
| 1902197155 | Monica Haydee Gonzalez | Dietitian, Registered | 1425 N Hunt Club Rd Ste 100, Gurnee, IL 60031-2632 | 2011-04-22 |
| 1972663466 | Rosalva Acosta | Physician Assistant | 1425 N Hunt Club Rd Ste 100, Gurnee, IL 60031-2632 | 2006-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881174720 | Rockelle Waggoner | Behavioral Analyst | 489 Tanglewood Dr, Gurnee, IL 60031 | 2018-08-20 |
| 1316434376 | Lake County Internal Medicine Assoc LLC | Non-Pharmacy Dispensing Site | 15 Tower Ct., Ste 190, Gurnee, IL 60031 | 2018-04-16 |
| 1588163364 | Advanced Endodontics, PC | Dentist | 103 S. Greenleaf Street, Suite K, Gurnee, IL 60031 | 2018-02-07 |
| 1578081550 | Northshore Medical Consultants, Ltd | Family Medicine | 1425 Hunt Club Rd. #302, Gurnee, IL 60031 | 2017-08-30 |
| 1336678739 | Sarah Beth Fugelseth | Nurse Practitioner | 1445 N Hunt Club Rd Ste 304, Gurnee, IL 60031 | 2017-06-08 |
| 1174079867 | Lifecarepros, LLC | In Home Supportive Care | 223 North Route 21, Gurnee, IL 60031 | 2016-09-01 |
| 1740733195 | Ryan Lee Winslow | Chiropractor | 6021 Washington St, Unit B, Gurnee, IL 60031 | 2016-08-02 |
| 1891129599 | Smart Scan Mri, LLC | Clinic/Center | 350 S. Greenleaf, Suite 401, Gurnee, IL 60031 | 2013-08-29 |
| 1568720076 | Yudelca Romano | Genetic Counselor, MS | 1125 Tri State Parkway, Gurnee, IL 60031 | 2012-05-03 |
| 1558637348 | Laura E Novak | Social Worker | 4212 Old Grand Avenue, Gurnne, IL 60031 | 2012-03-27 |
| Find all providers in zip 60031 | ||||
| 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 |
|---|---|---|---|---|
| 1578081550 | Northshore Medical Consultants, Ltd | Family Medicine | 1425 Hunt Club Rd. #302, Gurnee, IL 60031 | 2017-08-30 |
| 1770918302 | Ronald Allan Ferguson | Family Medicine | 17885 W Pond Ridge Cir, Gurnee, IL 60031-1669 | 2013-09-13 |
| 1326363896 | Evan Sterling Plowgian | Family Medicine | 7900 Rollins Rd Ste B1300, Gurnee, IL 60031 | 2010-03-28 |
| 1720318074 | Elba Maritza Villavicencio | Family Medicine | 7900 Rollins Rd, Suite1100, Gurnee, IL 60031-1512 | 2010-01-09 |
| 1154551620 | Tiffany Nicole Holland | Family Medicine | 25 Tower Ct Ste B, Gurnee, IL 60031-3318 | 2009-07-19 |
| 1417177429 | Barbara Gene Rund | Family Medicine | 4290 Woodlawn Ave, Gurnee, IL 60031-2727 | 2007-05-01 |
| 1750390381 | Saquib Majeed Ahmed | Family Medicine | 15 Tower Ct Ste 300, Gurnee, IL 60031-3346 | 2006-08-05 |
| 1679558068 | Taher Anwar Sobhy | Family Medicine | 1425 N Hunt Club Rd Ste 302, Gurnee, IL 60031-2639 | 2005-12-08 |
| 1417942822 | Luis I Salazar | Family Medicine | 1425 N Hunt Club Rd Ste 100, Gurnee, IL 60031-2632 | 2005-09-13 |
| 1245761295 | Lake County Primary Care S.c. | Family Medicine | 15 Tower Ct, Suite 255, Gurnee, IL 60031-3336 | 2017-03-22 |
| Find all providers in GURNEE | ||||
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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.