Avid Primary Care LLC
Organization Active NPI Geriatric Medicine (Family Medicine) Physician · Hazel Crest, IL
NPI 1295522688 · NPPES record last updated Jul 2, 2026
Key facts
- NPI
- 1295522688
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Geriatric Medicine (Family Medicine) Physician 207QG0300X
- Legal business name
- AVID PRIMARY CARE LLC
- Practice address
- 17465 Kedzie Ave
Hazel Crest, IL 60429-1632 - Phone
- (708) 887-7329
- Fax
- (708) 907-0771
- NPI assigned
- Apr 21, 2025
- Organization subpart
- No
Authorized official
- Name
- Ashraf Anani
- Title
- Authorized Official
- Phone
- (708) 887-7329
Practitioners 6
-
Johara Hassan, MD
-
Ashraf Anani, M.D.
-
Corinne Sadecki-Lund, APRN
-
John A Flick, D.O.
-
Amani Qasem, M.D.
-
Geoffrey F River, APN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251103002719 | IL | Part B Supplier - Clinic/Group Practice | 9436669629 |
Receives reassigned benefits from 6 practitioners Practice locations: Hazel Crest, IL; Orland Park, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician |
207QG0300X | Yes |
Addresses
Primary practice location
17465 Kedzie Ave
Hazel Crest, IL 60429-1632
Mailing address
17465 Kedzie Ave
Hazel Crest, IL 60429-1632
Phone (708) 887-7329
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All providers in Hazel Crest, IL · Geriatric Medicine (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 Jul 2, 2026. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.