Daniel P Vicencio, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036088743 Issued in IL

Practice address

2525 S Michigan Ave
B-390
Chicago, IL 60616-2333

Phone

(312) 567-6691

Fax

(312) 328-7702

NPI assigned

Dec 13, 2005

Last updated

May 6, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Northwestern University Feinberg Medical School, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Near North Health Service CorporationGroup PAC ID 9638165749, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: daniel.vicencio.1@31131.direct.athenahealth.com

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

• Near North Health Service Corporation

  dba Winfield Moody Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1821079088
  Medicare reassignment Care Compare group NPD
• Near North Health Service Corporation

  dba Near North Health Family Health Center at Oakwood Shores

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1740166255
  NPD
• Near North Health Service Corporation

  dba Louise Landau Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1831170059
  NPD
• Pathology Consultants of Chicago, LTD.

  • Anatomic Pathology & Clinical Pathology Physician
  • Chicago, IL
  • NPI 1689690562
  NPD
• Edna Richard M D

  • Gynecology Physician
  • Chicago, IL
  • NPI 1841405396
  NPD (past)

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1174508246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 S MICHIGAN AVE",
            "address_2": "B-390",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162333",
            "telephone_number": "312-567-6691",
            "fax_number": "312-328-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 S MICHIGAN AVE",
            "address_2": "B-390",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162333",
            "telephone_number": "312-567-6691",
            "fax_number": "312-328-7702"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1276 N Clybourn Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606102089",
            "country_code": "US",
            "telephone_number": "312-337-1073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICENCIO",
        "first_name": "DANIEL",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036088743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Maddix Vickers

• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.