Michigan Avenue Primary Care, S.C.
Organization Active NPI Family Medicine Physician · Chicago, IL
NPI 1013239672 · NPPES record last updated Jan 22, 2013
Key facts
- NPI
- 1013239672
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MICHIGAN AVENUE PRIMARY CARE, S.C.
- Practice address
- 180 N Michigan Ave
Suite 1605
Chicago, IL 60601-7478 - Phone
- (312) 201-1234
- Fax
- (312) 201-1202
- NPI assigned
- Feb 24, 2010
- Organization subpart
- No
Authorized official
- Name
- James A Runke, MD
- Title
- Medical Director
- Phone
- (312) 201-1234
Practitioners 10
-
Mona Clor, MD
-
Anne-Sophie Kim, MD
-
Niby Mathew, M.D.
-
James A Runke, M.D.
-
Carrie Salvia, D.O.
-
Jocelin Gamez, PA-C
-
Nathan Jent, PA-C
-
Lester Stephen Montesa, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2060887 | Michigan Avenue Primary Care | Provider-performed microscopy | Jun 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130209000016 | IL | Part B Supplier - Clinic/Group Practice | 4385898865 |
Receives reassigned benefits from 10 practitioners Practice locations: Chicago, IL |
National Provider Directory
Locations
180 N Michigan Ave
Ste 1607
Chicago, IL 60601
180 N Michigan Ave
Ste 1720
Chicago, IL 60601
Phone (312) 994-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X |
Addresses
Primary practice location
180 N Michigan Ave
Suite 1605
Chicago, IL 60601-7478
Mailing address
180 N Michigan Ave
Suite 1605
Chicago, IL 60601-7478
Phone (312) 201-1234
Other providers in Chicago, IL
- Michigan Avenue Center for Health, LTD.
- Michigan Avenue ENT P.C.
- Michigan Avenue Hearing Health P.C.
- Michigan Avenue Immediate Care
- Michigan Avenue Internists
- Michigan Avenue Psychotherapy, LLC
- Michigan Chicago CVS LLC
- Ruth Michon
- Victoria Michonski
- Michrid Supplies LLC
All providers in Chicago, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.