NORTHSIDE-SUBURBAN PEDIATRIC ASSOCIATES, S.C. (NPI# 1902802770) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902802770 |
| Entity Type | Organization |
| Organization Name | NORTHSIDE-SUBURBAN PEDIATRIC ASSOCIATES, S.C. |
| Practice Address |
4801 W Peterson Ave Ste 506 Chicago IL 60646-5795 |
| Practice Telephone | 7737775437 |
| Practice Fax Number | 7737777567 |
| Mailing Telephone | 7737775437 |
| Mailing Fax Number | 7737777567 |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MARY DEUTSCH (ADMINISTRATOR/MANAGER) |
| Authorized Official Telephone | 7737775437 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | IL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE SHIELD PROVIDER # | 01615555 | 01 |
| Street Address |
4801 W PETERSON AVE STE 506 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60646-5795 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588667315 | Barry M Leavitt | Psychologist | 4801 W Peterson Ave, Ste 525, Chicago, IL 60646 | 2005-05-24 |
| 1790229441 | Valerie Deutsch | Behavioral Analyst | 4801 W Peterson Ave, Suite 512, Chicago, IL 60646-5713 | 2016-12-15 |
| 1730623729 | A Dragonfly Mind, LLC | Clinical Neuropsychologist | 4801 W Peterson Ave, Suite 301, Chicago, IL 60646-5726 | 2016-12-09 |
| 1760938260 | Catherine Bogacki | Social Worker | 4801 W Peterson Ave, Suite 308, Chicago, IL 60646-5713 | 2016-08-25 |
| 1841662434 | Paul Robert Muhr | Dentist | 4801 W Peterson Ave, Suite 407, Chicago, IL 60646-5713 | 2015-10-22 |
| 1548631245 | Amy Derusha | Behavioral Analyst | 4801 W Peterson Ave, 512, Chicago, IL 60646-5713 | 2015-10-07 |
| 1063818813 | Amalia Pepek | Nurse Practitioner | 4801 W Peterson Ave, Suite 506, Chicago, IL 60646-5713 | 2014-11-06 |
| 1689089286 | Roxanne Gayle | Behavioral Analyst | 4801 W Peterson Ave, #512, Chicago, IL 60646-5713 | 2014-06-23 |
| 1982018461 | Superior Rehab Center LLC | Physical Therapist | 4801 W Peterson Ave, 615, Chicago, IL 60646-5713 | 2014-06-12 |
| 1720415367 | Frank J Gutierrez | Counselor | 4801 W Peterson Ave, Suite 403, Chicago, IL 60646 | 2013-09-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801312087 | Manal Ibrahim | Dentist | 6228 N Keystone Ave, Chicago, IL 60646 | 2017-08-18 |
| 1750820742 | Kaitlin O'brien | Student in an Organized Health Care Education/Training Program | 5801 N Pulaski, Chicago, IL 60646 | 2017-02-23 |
| 1659810646 | Sofia Trani | Student in an Organized Health Care Education/Training Program | 5801 N. Pulaski Rd, Chicago, IL 60646 | 2017-02-23 |
| 1487191151 | Ronald E. Rysztogi | Naprapath | 5704 N. Austin, Chicago, IL 60646 | 2017-01-19 |
| 1417403148 | Joyful Dental Care | Clinic/Center | 6314 N. Cicero Avenue, Chicago, IL 60646 | 2016-09-01 |
| 1164889754 | Physicians At Call | Family Medicine | 5901 N. Cicero Ave, Ste 207, Chicago, IL 60646 | 2016-01-27 |
| 1245610617 | Arlett Payne | Physician Assistant | 5906 N Milwaukee, Chicago, IL 60646 | 2015-06-01 |
| 1811375843 | North River Mental Health Center | Community/Behavioral Health | 5801 North Pulaski Road, Chicago, IL 60646 | 2015-05-11 |
| 1003157298 | Family Choice Home Health | Homemaker | 5933 N Milwaukee Avenue, Chicago, IL 60646 | 2013-03-13 |
| 1235479593 | Antonina Skapars Trinkuns | Psychiatry & Neurology | 6404 N. Tahoma Ave., Chicago, IL 60646 | 2013-02-25 |
| Find all providers in zip 60646 | ||||
| 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.