Family Wellness Clinic LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036101711 Issued in IL

Legal business name

FAMILY WELLNESS CLINIC LTD

Practice address

410 E Northwest Hwy
Mount Prospect, IL 60056-3305

Phone

(847) 632-1680

Fax

(847) 632-1681

NPI assigned

Jan 9, 2007

Organization subpart

No

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

Authorized official

Name

Raymond Gomez, M.D.NPI 1598784829

Title

Direct Owner

Phone

(847) 632-1680

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raymond Gomez, M.D.

  • Family Medicine Physician
  • Mount Prospect, IL
  • NPI 1598784829
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664150400000",
    "number": "1083763866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 E NORTHWEST HWY",
            "city": "MOUNT PROSPECT",
            "state": "IL",
            "postal_code": "600563305",
            "telephone_number": "847-632-1680",
            "fax_number": "847-632-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E NORTHWEST HWY",
            "city": "MOUNT PROSPECT",
            "state": "IL",
            "postal_code": "600563305",
            "telephone_number": "847-632-1680",
            "fax_number": "847-632-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY WELLNESS CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "DIRECT OWNER",
        "authorized_official_telephone_number": "847-632-1680",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036101711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036101711",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn L Eubanks, MD
• Euclid Advanced Dentistry, P.C
• Patricia Evangelou
• Excellence Safe Home Care LLC
• Family Medicine Specialists of Mount Prospect S C
• Fantastic Smiles LTD.
• Mary Farley, APRN
• Feyintolu M. Balogun, DPM PLLC
• William Bartley Finnerty, PHARM.D.
• First Smile HD 3D 4D Ultrasound LLC

• Family Medicine Physician in Mount Prospect, IL
• Providers in Mount Prospect, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.