Organization Active NPI

At Your Door Physician Care

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1154901783
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AT YOUR DOOR PHYSICIAN CARE
Practice address
5525 S Emerald Ave
Chicago, IL 60621-2953
Phone
(312) 636-3722
NPI assigned
Apr 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Authorized official

Name
Ms. Taryrsha Davis, NURSE PRACTITIONERNPI 1821552761
Title
Nurse Practitioner
Phone
(312) 636-3722

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Home Health Agency 251E00000X
In Home Supportive Care Agency 253Z00000X
Clinic/Center 261Q00000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X

Addresses

Primary practice location

5525 S Emerald Ave
Chicago, IL 60621-2953

Mailing address

5525 S Emerald Ave
Chicago, IL 60621-2953
Phone (312) 636-3722

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211213002471 IL Part B Supplier - Clinic/Group Practice 3678963279 Receives reassigned benefits from 2 practitioners
Practice locations: Wood Dale, IL

National Provider Directory

National Provider Directory

Locations

17504 E Carriageway Dr
Hazel Crest, IL 60429
Phone (773) 299-9299

343 N Wood Dale Rd
Ste 102
Wood Dale, IL 60191
Phone (773) 299-9299

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1617840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1154901783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5525 S EMERALD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606212953",
            "telephone_number": "312-636-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5525 S EMERALD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606212953",
            "telephone_number": "312-636-3722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AT YOUR DOOR PHYSICIAN CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-08",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "TARYRSHA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "312-636-3722",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "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 Apr 7, 2022; 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.