Active NPI
Raphael Medical Services Corp.
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1326517814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- RAPHAEL MEDICAL SERVICES CORP.
- Practice address
- 4646 N Marine Dr Ste C6300
Chicago, IL 60640-5759 - Phone
- (773) 564-5781
- NPI assigned
- Nov 14, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Tade Akere
- Title
- Manager
- Phone
- (773) 564-5781
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
4646 N Marine Dr Ste C6300
Chicago, IL 60640-5759
Mailing address
1516 Fowler Ave
Evanston, IL 60201-3955
Phone (773) 564-5781
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036094343 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Raphael Medical Services Corp
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Chicago, IL
- NPI 1821566977
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": "1542153600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1560902400000",
"number": "1326517814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1516 FOWLER AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602013955",
"telephone_number": "773-564-5781",
"fax_number": "773-564-5782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4646 N MARINE DR STE C6300",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606405759",
"telephone_number": "773-564-5781"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RAPHAEL MEDICAL SERVICES CORP.",
"organizational_subpart": "NO",
"enumeration_date": "2018-11-14",
"last_updated": "2019-06-19",
"status": "A",
"authorized_official_last_name": "AKERE",
"authorized_official_first_name": "TADE",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "773-564-5781",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036094343",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
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 Jun 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.