Individual provider Active NPI

Wesley Gibbert

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1255862157
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036152615 Issued in IL
Practice address
4747 N Kedzie Ave
Chicago, IL 60625-4420
Phone
(312) 666-3494
NPI assigned
Mar 22, 2017
Last updated
Aug 9, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036152615 IL Primary

Addresses

Primary practice location

4747 N Kedzie Ave
Chicago, IL 60625-4420

Mailing address

2750 W North Ave
Chicago, IL 60647-5247
Phone (312) 666-3494

Other practice location 1

2750 W North Ave
Chicago, IL 60647-5247
Phone (312) 666-3494

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20201113001847 IL Practitioner - Family Practice 9335485242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Erie Family Health Center, IncGroup PAC ID 9537050422, 141 clinicians

Practice addresses (Care Compare)

1504 S Albany Ave
Chicago, IL 60623-2209
Phone (312) 666-3494

4747 N Kedzie Ave
Chicago, IL 60625-4420
Phone (312) 666-3494

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Erie Family Health Center, Inc CurrentSince Aug 17, 2020 Accepting new patients
Erie Family Health Center Inc CurrentSince Aug 17, 2020 Accepting new patients
Erie Family Health Center, Inc Current Accepting new patients

Locations

1504 S Albany Ave
Chicago, IL 60623

1701 W Superior St
Chicago, IL 60622
Phone (312) 432-7392

1701 W Superior St
#3
Chicago, IL 60622

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-2056

2750 W North Ave
Chicago, IL 60647
Phone (312) 432-2767

4747 N Kedzie Ave
Chicago, IL 60625

Interoperability endpoints

  • Direct secure messaging: wgibbert368147@direct.ochin.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1255862157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475247",
            "telephone_number": "312-666-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254420",
            "telephone_number": "312-666-3494"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2750 W North Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606475247",
            "country_code": "US",
            "telephone_number": "312-666-3494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBBERT",
        "first_name": "WESLEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-22",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036152615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.