Crestwood Associated Medical Center LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.103914 Issued in IL

Legal business name

CRESTWOOD ASSOCIATED MEDICAL CENTER LTD

Practice address

13705 Cicero Ave
Crestwood, IL 60418-1824

Phone

(708) 385-4416

Fax

(708) 388-8825

NPI assigned

Aug 10, 2017

Organization subpart

No

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

Authorized official

Name

Dr. John William Revello, D.C.NPI 1710928056

Title

President

Phone

(708) 385-4416

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

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

• John W. Revello, D.C.

  • Chiropractor
  • Orland Park, IL
  • NPI 1710928056
  Medicare reassignment NPD Authorized official
• Krishna D Parameswar, M.D.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Elgin, IL
  • NPI 1780620690
  Medicare reassignment NPD
• Vincent Michael Tupper, M.D.

  • Anesthesiology Physician
  • Chicago, IL
  • NPI 1609139583
  Medicare reassignment NPD

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

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1104341163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13705 S. CICERO AVE.",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "60445",
            "telephone_number": "708-385-4416",
            "fax_number": "708-388-8825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13705 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604181824",
            "telephone_number": "708-385-4416",
            "fax_number": "708-388-8825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD ASSOCIATED MEDICAL CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-10",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "REVELLO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-385-4416",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010310",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.103914",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "036039801",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070.005243",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shavon Clark-Howard, RPH
• Dillon Clemmer
• Emily Coleman
• Erica M Coleman, COTA/L
• Cheryl Ann Connelly, MS SLP/CCC
• Crestwood Care Centre LP
• Crestwood Chiropractic and Rehab
• Crestwood Dental and TMJ Care PC
• Crestwood Dental Care PC (Family Dental Care)
• Crestwood Medical Associates LTD

• Family Medicine Physician in Crestwood, IL
• Providers in Crestwood, 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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.