NPIMap

Individual provider Active NPI

Tracey M Davenport, M.D.

  • Internal Medicine Physician
  • Lincolnwood, IL
National Provider Identifier
1114033826
Registry record updated Jan 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-114303 Issued in IL
Practice address
7301 N Lincoln Ave
Lincolnwood, IL 60712-1709
Phone
(224) 766-7669
Fax
(847) 674-0892
NPI assigned
Aug 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2018

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 036-114303 IL Primary

Addresses

Primary practice location

7301 N Lincoln Ave
Lincolnwood, IL 60712-1709

Mailing address

1333 Butterfield Rd
Ste 130
Downers Grove, IL 60515-5641
Phone (630) 371-0133

Other names 1

  • Tracey Alqasem Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051103000670 IL Practitioner - Internal Medicine 5799703245 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Southern Illinois University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Davenport Medical IncGroup PAC ID 0244613628, 2 clinicians

Practice addresses (Care Compare)

1023 Mapleton Ave
Oak Park, IL 60302-1405
Phone (773) 543-8964

Hospital & facility affiliations

  • Accucare Physical Therapy and Rehabilitation Services Home health agency, Saint Charles, IL, CCN 147926
  • Safe Life Home Health Care, LLC Home health agency, Lombard, IL, CCN 148319
  • Anchor Home Health Care Agency, Inc Home health agency, Palos Hills, IL, CCN 147845
  • Vision Home Health Care, Inc Home health agency, Skokie, IL, CCN 148090
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-114303ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Homecare Docs LLC CurrentSince Jan 1, 2016 Accepting new patients
Gude Medical S C Internal Medicine CurrentSince Jul 1, 2022 Accepting new patients
Vpa PC Internal Medicine CurrentSince Jan 1, 2016 Accepting new patients
Simpkins Medical Inc CurrentSince Jun 28, 2022 Accepting new patients
Vpa PC Internal Medicine CurrentSince Jan 1, 2016 Accepting new patients
Onsite Health Therapies, LLC CurrentSince May 1, 2021 Accepting new patients
Davenport Medical Inc Internal Medicine CurrentSince Jul 8, 2022 Accepting new patients
Gemini Health and Wellness LLC Internal Medicine PastSince Oct 14, 2024 Accepting new patients

Locations

1000 Burr Ridge Pkwy
Ste 201
Burr Ridge, IL 60527
Phone (312) 818-4650

7301 N Lincoln Ave
Ste 180
Lincolnwood, IL 60712
Phone (224) 766-7669

1480 Renaissance Dr
Ste 414
Park Ridge, IL 60068
Phone (847) 813-6216

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515542400000",
    "number": "1114033826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 BUTTERFIELD RD",
            "address_2": "STE 130",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155641",
            "telephone_number": "630-371-0133",
            "fax_number": "630-371-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 N LINCOLN AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607121709",
            "telephone_number": "224-766-7669",
            "fax_number": "847-674-0892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "TRACEY",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2018-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-114303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "ALQASEM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lincolnwood, IL

Sources for this page

Verify at the official NPI Registry.