Advanced Family Medicine, PLLC
Organization Active NPI Family Medicine Physician · La Grange Highlands, IL
NPI 1235925587 · NPPES record last updated Apr 23, 2025
Key facts
- NPI
- 1235925587
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ADVANCED FAMILY MEDICINE, PLLC
- Practice address
- 5201 Willow Springs Rd Ste 180
La Grange Highlands, IL 60525-6506 - Phone
- (708) 929-6099
- Fax
- (708) 929-6169
- NPI assigned
- Apr 15, 2025
- Organization subpart
- No
Authorized official
- Name
- Toni Conwell
- Title
- Practice Manager
- Phone
- (708) 712-4381
Practitioners 2
-
Daniel Chen, DO
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2319444 | Advanced Family Medicine | Certificate of waiver | Feb 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250530002040 | IL | Part B Supplier - Clinic/Group Practice | 6507375755 |
Receives reassigned benefits from 2 practitioners Practice locations: La Grange Highlands, IL |
National Provider Directory
Locations
5201 Willow Springs Rd
Ste 180
La Grange Highlands, IL 60525
Phone (708) 579-9705
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
5201 Willow Springs Rd Ste 180
La Grange Highlands, IL 60525-6506
Mailing address
5201 Willow Springs Rd Ste 180
La Grange Highlands, IL 60525-6506
Phone (708) 929-6099
Other providers in La Grange Highlands, IL
- Advanced Healthcare for Women,LTD.
- Adventist Health Partners, Inc
- Jaafar Afshar
- Afzal Ahmad
- Jyotika C Amin
All providers in La Grange Highlands, 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 23, 2025. 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.