Fenix Family Health Center Inc.
Organization Active NPI Family Medicine Physician · Highwood, IL
NPI 1124356431 · NPPES record last updated Apr 5, 2011
Key facts
- NPI
- 1124356431
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 336-044483
- Legal business name
- FENIX FAMILY HEALTH CENTER INC.
- Practice address
- 130 Washington Ave
Highwood, IL 60040-1122 - Phone
- (847) 909-2004
- Fax
- (847) 266-0961
- NPI assigned
- Nov 24, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Louise Berner-Holmberg, MD
- Title
- Director
- Phone
- (847) 909-2004
Practitioners 1
-
Louise Berner-Holmberg, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2015630 | Fenix Family Health Center | Certificate of waiver | Oct 28, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140117000376 | IL | Part B Supplier - Clinic/Group Practice | 8224266390 |
Receives reassigned benefits from 1 practitioner Practice locations: Highwood, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 336-044483 | Yes | |
| Primary Care Clinic/Center | 261QP2300X | 036082171 | IL |
Addresses
Primary practice location
130 Washington Ave
Highwood, IL 60040-1122
Mailing address
130 Washington Ave
Highwood, IL 60040-1122
Phone (847) 909-2004
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679788772 | Other | IL | NPI |
Other providers in Highwood, IL
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- Karla Ann Giese
- Hilary Sartain Grimm
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All providers in Highwood, 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 Apr 5, 2011. 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.
- 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.