Jacqueline Ann Pongracic, MD

Primary specialty

Pediatric Allergy/Immunology PhysicianTaxonomy code 2080P0201X

License

036083010 Issued in IL

Practice address

2515 N Clark St
Childrens Memorial Hospital Outpatient Center
Chicago, IL 60614

Phone

(312) 227-6010

Fax

(312) 227-9401

NPI assigned

Mar 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316563200000",
    "number": "1083674048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 CHILDRENS PLAZA",
            "address_2": "#60 CHILDRENS MEMORIAL HOSPITAL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60614",
            "telephone_number": "312-227-6011",
            "fax_number": "312-227-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 N CLARK ST",
            "address_2": "CHILDRENS MEMORIAL HOSPITAL OUTPATIENT CENTER",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60614",
            "telephone_number": "312-227-6010",
            "fax_number": "312-227-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONGRACIC",
        "first_name": "JACQUELINE",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2011-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "IL",
            "license": "036083010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083010",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karyn Pondel, LMT
• Ponder Mental Wellness, PLLC
• Haritha Ponduri, MSN, APRN, FNP-C
• Pong Medical Center LLC
• Supachai S Pongched, M.D.
• Abigail Poniente Monsalud
• Natalya Igorevna Ponomareva, MD
• Ponos Care Illinois, PLLC
• Maria del Carmen Pons Torres, MD, PHD
• Michael Anthony Pontarelli, D.C.

• Pediatric Allergy/Immunology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Allergy/Immunology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; 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.