Jeremiah Ozovehe Bello
Individual provider Active NPI Internal Medicine Physician · Chicago, IL
NPI 1063190833 · NPPES record last updated Jul 10, 2023
Key facts
- NPI
- 1063190833
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 125.082709 (IL)
- Practice address
- 1969 W Ogden Ave
Chicago, IL 60612-3765 - Phone
- (312) 864-6000
- NPI assigned
- Jul 10, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230822000416 | IL | Order and Referring Only - Internal Medicine |
4688036726 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.082709 | IL | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 125.082709 | IL | Yes |
Addresses
Primary practice location
1969 W Ogden Ave
Chicago, IL 60612-3765
Mailing address
1900 W Polk St
Chicago, IL 60612-3723
Phone (312) 864-7200
Other providers in Chicago, IL
- Rosa Bellido-Griffin
- Natalie E. Belling
- Giorgiana Bellisario
- Maria Camila Bello Torres
- Alfonso C. Bello
- John B Bello
- Otatade Bello
- Yahya B Bello
- Ryan Samuel Belloli
- Bells Haven Transportation
All providers in Chicago, IL · Internal 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 Jul 10, 2023. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.