NPIMap

Organization Active NPI

Macentee Knox & Vargas MDS

  • Preferred Provider Organization
  • Chicago, IL
National Provider Identifier
1275729303
Registry record updated Mar 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
036072512 Issued in IL
Legal business name
MACENTEE KNOX & VARGAS MDS
Practice address
10627 S Pulaski Rd
Chicago, IL 60655-3827
Phone
(773) 779-9300
Fax
(773) 779-5768
NPI assigned
Sep 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2011

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

Authorized official

Name
Dr. Peter F Macentee, M.D.NPI 1417045501
Title
President
Phone
(773) 779-9300

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 036072512 IL Primary
Preferred Provider Organization 305R00000X 036047977 IL
Point of Service 305S00000X 036063080 IL

Addresses

Primary practice location

10627 S Pulaski Rd
Chicago, IL 60655-3827

Mailing address

10627 S Pulaski Rd
Chicago, IL 60655-3827
Phone (773) 779-9300

Other names 1

  • SOUTHCARE FAMILY PRACTICE Doing business as

National Provider Directory

National Provider Directory

Locations

10627 S Pulaski Rd
Chicago, IL 60655
Phone (773) 779-9300

Practitioners & affiliated clinicians

Practitioners 1

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": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299542400000",
    "number": "1275729303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10627 S PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606553827",
            "telephone_number": "773-779-9300",
            "fax_number": "773-779-5768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10627 S PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606553827",
            "telephone_number": "773-779-9300",
            "fax_number": "773-779-5768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACENTEE KNOX & VARGAS MDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2011-03-08",
        "status": "A",
        "authorized_official_last_name": "MACENTEE",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-779-9300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "036072512",
            "primary": true
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "036047977",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "IL",
            "license": "036063080",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHCARE FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.