Individual provider Active NPI

Bruce A Parisi, M.D.

  • Family Medicine Physician
  • Calumet City, IL
National Provider Identifier
1003911009
Registry record updated Dec 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036066062 Issued in IL
Practice address
1600 167TH St Ste 500
Calumet City, IL 60409-5457
Phone
(708) 868-1170
Fax
(708) 868-1168
NPI assigned
Sep 14, 2006
Last updated
Dec 19, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036066062 IL Primary

Addresses

Primary practice location

1600 167TH St Ste 500
Calumet City, IL 60409-5457

Mailing address

27702 Network PL
Chicago, IL 60673-1277
Phone (708) 862-7674

Other identifiers 3

IdentifierTypeStateIssuer
036066062MedicaidIL
P01953164OtherILRRM
F400437236OtherILMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051209000289 IL Practitioner - Family Practice 4486683935 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rush Medical College of Rush University, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ucm Medical Group Sub LLCGroup PAC ID 4688635337, 101 clinicians

Practice addresses (Care Compare)

1 Ingalls Dr
Harvey, IL 60426-3558
Phone (708) 333-2300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ucm Medical Group Sub, LLC Family Medicine CurrentSince Jan 15, 2018 Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

1600 167th St
Ste 500
Calumet City, IL 60409
Phone (708) 868-1170

1600 167th St
Ste 800
Calumet City, IL 60409
Phone (708) 868-1170

27702 Network Pl
Chicago, IL 60673

19550 Governors Hwy
Ste 2000
Flossmoor, IL 60422
Phone (708) 272-6606

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

Interoperability endpoints

  • Direct secure messaging: bparisi202154@uchospital.direct-ci.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1003911009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27702 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731277",
            "telephone_number": "708-862-7674",
            "fax_number": "708-862-1781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 167TH ST STE 500",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604095457",
            "telephone_number": "708-868-1170",
            "fax_number": "708-868-1168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARISI",
        "first_name": "BRUCE",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036066062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036066062",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRM",
            "identifier": "P01953164",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "F400437236",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Calumet City, IL

Sources for this page

Verify at the official NPI Registry.