NPIMap

Organization Active NPI

Resilience Healthcare - Lakefront Medical Associates, LLC

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1013480359
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RESILIENCE HEALTHCARE - LAKEFRONT MEDICAL ASSOCIATES, LLC
Practice address
4700 N Marine Dr Ste 300
Chicago, IL 60640-7975
Phone
(844) 533-2464
NPI assigned
Jan 9, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Authorized official

Name
Manoj Prasad
Title
Ceo
Phone
(708) 763-6700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

4700 N Marine Dr Ste 300
Chicago, IL 60640-7975

Mailing address

4646 N Marine Dr
Chicago, IL 60640-5759

Other names 2

  • Chicago Health Medical Group Doing business as
  • CHMG - Lakefront Other name

National Provider Directory

National Provider Directory
Tax ID family
Chicago Health Medical Group14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18552/brand/2/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1546992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672272000000",
    "number": "1013480359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 N MARINE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N MARINE DR STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407975",
            "telephone_number": "844-533-2464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESILIENCE HEALTHCARE - LAKEFRONT MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-09",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A",
        "authorized_official_last_name": "PRASAD",
        "authorized_official_first_name": "MANOJ",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-763-6700"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chicago Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHMG - Lakefront",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CHMG - Lakefront",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Dec 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.