NPIMap

Organization Active NPI

Presence Healthcare Services

  • Orthopaedic Surgery Physician
  • Chicago, IL
National Provider Identifier
1336428101
Registry record updated Apr 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PRESENCE HEALTHCARE SERVICES
Practice address
1431 N Western Ave
Suite 134
Chicago, IL 60622-1797
Phone
(773) 235-1915
Fax
(773) 235-1999
NPI assigned
Aug 11, 2011
Last updated
Apr 10, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2013

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

Authorized official

Name
Mrs. Melvonne Wickliffe-Jones
Title
Credentialing MGR
Phone
(630) 914-2417

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X IL
Orthopaedic Surgery Physician 207X00000X Primary

Addresses

Primary practice location

1431 N Western Ave
Suite 134
Chicago, IL 60622-1797

Mailing address

1000 Remington Boulevard
Bolingbrook, IL 60440-0000
Phone (630) 914-2417

Other identifiers 1

IdentifierTypeStateIssuer
745367OtherILMEDICARE PTAN

Other names 1

  • Resurrection Services Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050215000965 IL Part B Supplier - Clinic/Group Practice 2860396769 Receives reassigned benefits from 128 practitioners
47 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 46

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 46

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365552000000",
    "number": "1336428101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 REMINGTON BOULEVARD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604400000",
            "telephone_number": "630-914-2417",
            "fax_number": "630-914-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 N WESTERN AVE",
            "address_2": "SUITE 134",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221797",
            "telephone_number": "773-235-1915",
            "fax_number": "773-235-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2013-04-10",
        "status": "A",
        "authorized_official_last_name": "WICKLIFFE-JONES",
        "authorized_official_first_name": "MELVONNE",
        "authorized_official_title_or_position": "CREDENTIALING MGR",
        "authorized_official_telephone_number": "630-914-2417",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "745367",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Resurrection Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Apr 10, 2013; 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.

Verify at the official NPI Registry.