Active NPI
Paul Diaz
- Other Technician
- Chicago, IL
National Provider Identifier
1013360429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 001159
- Practice address
- 2133 W Lexington St
Chicago, IL 60612-3707 - Phone
- (312) 746-7824
- Fax
- (312) 746-6526
- NPI assigned
- Jul 20, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 001159 | IL | Primary |
Addresses
Primary practice location
2133 W Lexington St
Chicago, IL 60612-3707
Mailing address
333 S State St
Chicago, IL 60604-3900
Phone (312) 747-9545
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001159 | Other | IL | IDPHLICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001159 | IL | MD | Other Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chicago City of | Technician, Other | Past | Accepting new patients |
| City of Chicago | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community Health Clinic/Center
- Chicago, IL
- NPI 1194725192
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468972800000",
"number": "1013360429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 S STATE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606043900",
"telephone_number": "312-747-9545",
"fax_number": "312-745-7603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2133 W LEXINGTON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123707",
"telephone_number": "312-746-7824",
"fax_number": "312-746-6526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-20",
"last_updated": "2016-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "IL",
"license": "001159",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDPHLICENSE",
"identifier": "001159",
"state": "IL"
}
],
"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 Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.