Daphne Tessalee, MD
Individual provider Active NPI Family Medicine Physician · La Grange, IL
NPI 1124078357 · NPPES record last updated Mar 24, 2021
Key facts
- NPI
- 1124078357
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 36094766 (IL)
- Practice address
- 1325 Community Memorial Dr
La Grange, IL 60525-2659 - Phone
- (708) 245-8900
- Fax
- (708) 245-5604
- NPI assigned
- May 10, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Rush Medical College of Rush University, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Adventist Midwest Health
Practice addresses (Care Compare)
1325 Community Memorial Dr
La Grange, IL 60525-2659
Phone (708) 245-8900
5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone (708) 245-9000
Hospital & facility affiliations
- Uchicago Medicine Adventhealth la Grange
- Uchicago Medicine Adventhealth Hinsdale
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100422001135 | IL | Practitioner - Family Practice | 2466589460 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36094766 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adventist Midwest Health | Family Medicine | Current |
Accepting new patients |
| Adventist Midwest Health | Current |
Accepting new patients |
Locations
5201 Willow Springs Rd
La Grange Highlands, IL 60525
Phone (630) 323-5214
5101 Willow Springs Rd
Lagrange Hlds, IL 60525
Phone (708) 245-4073
1325 Memorial Dr
Lagrange Hlds, IL 60525
Phone (708) 245-8900
2434 Wolf Rd
Westchester, IL 60154
Phone (630) 856-6800
Interoperability endpoints
- dtessalee1240260@adventhealth.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36094766 | IL | Yes |
Addresses
Primary practice location
1325 Community Memorial Dr
La Grange, IL 60525-2659
Mailing address
1325 Community Memorial Dr
La Grange, IL 60525-2659
Phone (708) 245-8900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036094766 | Medicaid | IL |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | daphne.tessalee.1@380.direct.athenahealth.com |
Other providers in La Grange, IL
- Kimberly Swidergal
- Sue Szumigalski
- Hannah Tate
- Taylor Wolfram, LLC
- Teamvision Mso LLC
- Chantel Tessmer
- Thayer Counseling, LTD
- Alison Thayer
- The Dental Loft, LLC
- Thomas J Cahill PHD PC
All providers in La Grange, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.