PRIMECARE NEPHROLOGY & HYPERTENSION SC CORP (NPI# 1952656167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952656167 |
| Entity Type | Organization |
| Organization Name | PRIMECARE NEPHROLOGY & HYPERTENSION SC CORP |
| Practice Address |
4810 S Kenwood Ave Chicago IL 60615-2016 |
| Practice Telephone | 7086090197 |
| Practice Fax Number | 7083381790 |
| Mailing Telephone | 7086090197 |
| Mailing Fax Number | 7083381780 |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2015-12-07 |
| Authorized Official Name | DR. OSVALDO ENRIQUE WAGENER (PRESIDENT) |
| Authorized Official Telephone | 7086090197 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
036086015 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
4810 S KENWOOD AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60615-2016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578170221 | Cook County | Technician, Other | 430 East 51st Pl, Chicago, IL 60615 | 2020-09-28 |
| 1700498326 | Connie Frances Davis | Massage Therapist | 5481 S. Cornell, Chicago, IL 60615 | 2020-08-17 |
| 1134781974 | Lifestyle Rejuvenation Medical Group Pllc | Chiropractor | 1740 E 55th Street, Chicago, IL 60615 | 2019-07-02 |
| 1275007767 | Michelle Alyse Costello | Social Worker | 1225 E 53rd St, Suite 606, Chicago, IL 60615 | 2019-01-17 |
| 1194207522 | Cindy Louise Lys | Social Worker | 1525 E 53rd Street Suite 516-4, Chicago, IL 60615 | 2018-09-01 |
| 1861983660 | Pranusha Pinna | Student in an Organized Health Care Education/Training Program | 1850 W. Harrison St., Chicago, IL 60615 | 2018-05-29 |
| 1528577632 | Jonah Waseberg | Counselor | 1100 E.55th St, Chicago, IL 60615 | 2017-09-21 |
| 1710404496 | Tawann Jackson | Psychologist | 360 Blair Lane, Door 13, Bolingbrook, IL 60615 | 2017-08-24 |
| 1194259069 | Molly Kachale Netter | Nurse Practitioner | 1554 E 55th St., Chicago, IL 60615 | 2017-04-17 |
| 1205387990 | Kirk Remon Riddle | Counselor | 1525 E. 53rd Street, Suite 425, Chicago, IL 60615 | 2016-10-18 |
| Find all providers in zip 60615 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://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 |
|---|---|---|---|---|
| 1235627332 | Chicago Nephrology Associates, LLC | Internal Medicine | 3023 N Clark St #302, Chicago, IL 60657 | 2018-04-25 |
| 1619328820 | Nay Seif | Internal Medicine | 675 N Saint Clair St Ste 250, Chicago, IL 60611-5975 | 2016-06-29 |
| 1447611389 | Skyline Medical Associates LLC | Internal Medicine | 100 E 14th St Apt 1907, Chicago, IL 60605-3673 | 2016-03-18 |
| 1972936581 | Marshall David Lindheimer | Internal Medicine | 5807 S Dorchester Ave, 5e, Chicago, IL 60637-1729 | 2013-08-19 |
| 1558650697 | Stephanie Michelle Toth-manikowski | Internal Medicine | 820 S Wood St # Mc793, Chicago, IL 60612 | 2011-03-29 |
| 1326372855 | Daniel Fantus | Internal Medicine | 240 E Huron St Ste 1-200, Chicago, IL 60611-2909 | 2009-09-30 |
| 1487882791 | Sylvester Barnes Iv | Internal Medicine | 900 S Clark St Apt 1801, Chicago, IL 60605 | 2009-06-24 |
| 1952551517 | Jane Vernik Md, S.c. | Internal Medicine | 637 South Wood Street St 215, Division of Nephrology, Durand Building, Chicago, IL 60612 | 2008-09-19 |
| 1073643193 | Malathi Shah | Internal Medicine | 1625 E 75th St Ste 328, Chicago, IL 60649-3603 | 2007-03-07 |
| 1518033315 | Patrick N Cunningham | Internal Medicine | University of Chicago, Section of Nephrology, Mc 5100, 5841 South Maryland Ave., Chicago, IL 60637 | 2006-11-27 |
| 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.