NPIMap

Organization Active NPI

Nowobilska Medical Practice LTD

  • Primary Care Clinic/Center
  • Chicago, IL
National Provider Identifier
1013217785
Registry record updated Feb 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
036070270 Issued in IL
Legal business name
NOWOBILSKA MEDICAL PRACTICE LTD
Practice address
5257 S Cicero Ave
Chicago, IL 60632-4915
Phone
(773) 735-8038
Fax
(800) 640-0772
NPI assigned
Oct 28, 2010
Last updated
Feb 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2011

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

Authorized official

Name
Mr. Casey Malik
Title
Administrator
Phone
(773) 735-8182

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 036070270 IL Primary

Addresses

Primary practice location

5257 S Cicero Ave
Chicago, IL 60632-4915

Mailing address

5257 S Cicero Ave
Chicago, IL 60632-4915
Phone (773) 735-8038

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110112000726 IL Part B Supplier - Clinic/Group Practice 5991994543 Receives reassigned benefits from 7 practitioners
Practice locations: Chicago, IL; Oak Lawn, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297209600000",
    "number": "1013217785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5257 S CICERO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606324915",
            "telephone_number": "773-735-8038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5257 S CICERO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606324915",
            "telephone_number": "773-735-8038",
            "fax_number": "800-640-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOWOBILSKA MEDICAL PRACTICE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-28",
        "last_updated": "2011-02-09",
        "status": "A",
        "authorized_official_last_name": "MALIK",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "773-735-8182",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036070270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.