NPIMap

Organization Active NPI

Longevity Accountable Care, PA

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1144078965
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LONGEVITY ACCOUNTABLE CARE, PA
Practice address
6300 N California Ave
Chicago, IL 60659-1702
Phone
(773) 973-1900
NPI assigned
May 7, 2024
Last updated
May 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
LONGEVITY ACCOUNTABLE CARE, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Authorized official

Name
Diane Vincur
Title
Practice Manager
Phone
(561) 815-2427

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X NU
Primary Care Nurse Practitioner 363LP2300X NU
Family Medicine Physician 207Q00000X NU Primary
Geriatric Medicine (Family Medicine) Physician 207QG0300X NU

Addresses

Primary practice location

6300 N California Ave
Chicago, IL 60659-1702

Mailing address

11780 US Highway 1 Ste N107
North Palm Beach, FL 33408-3007
Phone (561) 815-2427

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240717003454 IL Part B Supplier - Clinic/Group Practice 0840734034 Receives reassigned benefits from 20 practitioners
Practice locations: Lake Zurich, IL; Lombard, IL; Long Grove, IL; Morton Grove, IL; Crestwood, IL; Mundelein, IL; Northbrook, IL; Riverwoods, IL…

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Longevity Accountable Care5 organizations share this tax ID, including this one
Part of
Longevity Accountable Care

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1144078965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11780 US HIGHWAY 1 STE N107",
            "city": "NORTH PALM BEACH",
            "state": "FL",
            "postal_code": "334083007",
            "telephone_number": "561-815-2427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 N CALIFORNIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606591702",
            "telephone_number": "773-973-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY ACCOUNTABLE CARE, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONGEVITY ACCOUNTABLE CARE, PA",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "VINCUR",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "561-815-2427"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; 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.