Individual provider Active NPI

Cedric L Coleman, MD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1104809755
Registry record updated Apr 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036067164 Issued in IL
Practice address
10719 S Western Ave
Chicago, IL 60643-3135
Phone
(773) 941-5156
Fax
(708) 229-1611
NPI assigned
Nov 28, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036067164 IL Primary

Addresses

Primary practice location

10719 S Western Ave
Chicago, IL 60643-3135

Mailing address

10719 S Western Ave
Chicago, IL 60643-3135
Phone (773) 941-5156

Other identifiers 1

IdentifierTypeStateIssuer
036067164MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110222000990 IL Practitioner - Internal Medicine 8729269899 Practice locations: Chicago, IL

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10801 S Western Ave
Suite 205
Chicago, IL 60643-3225
Phone 7082291600708229

Hospital & facility affiliations

  • Comfort Care LLC Home health agency, Chicago, IL, CCN 148295
  • Advocate Trinity Hospital Hospital, Chicago, IL, CCN 140048
  • Osf Little Company of Mary Medical Center Hospital, Evergreen Park, IL, CCN 140179
  • Advocate Christ Hospital & Medical Center Hospital, Oak Lawn, IL, CCN 140208

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GICBCA/Endpoint/GICBCA

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775606400000",
    "number": "1104809755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10719 S WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606433135",
            "telephone_number": "773-941-5156",
            "fax_number": "708-229-1611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10719 S WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606433135",
            "telephone_number": "773-941-5156",
            "fax_number": "708-229-1611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "CEDRIC",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036067164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067164",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.