Family Doctor Medical Center

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

036101658 Issued in IL

Legal business name

FAMILY DOCTOR MEDICAL CENTER

Practice address

1918 W Irving Park Rd
Chicago, IL 60613-2408

Phone

(773) 940-1612

NPI assigned

Sep 1, 2015

Last updated

Sep 1, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

FAMILY DOC, INC.As reported in NPPES

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

Authorized official

Name

Julia Jackson, MA

Title

Office Manager

Phone

(773) 940-1612

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Family Doc Inc

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Family Doc, Inc.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1700117942
  NPPES parent name

Practitioners 1

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.

• Adebayo Bademosi, M.D.

  • Family Medicine Physician
  • Munster, IN
  • NPI 1346357076
  NPD (past)

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1336516780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132408",
            "telephone_number": "773-940-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132408",
            "telephone_number": "773-940-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DOCTOR MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY DOC, INC.",
        "enumeration_date": "2015-09-01",
        "last_updated": "2015-09-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JULIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "773-940-1612",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IL",
            "license": "036101658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20000890",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Family Dental Group, Inc.
• Family Dental of Park Ridge PLLC
• Family Dental of Roscoe Inc
• Family Doc S.C.
• Family Doc, Inc.
• Family Doctors-Family Health Care, S.C.
• Family Eyecare Alexis E Scatchell OD
• Family Eyecare Alexis E Scatchell OD (Eyestyle Family Optical)
• Family Farmacia Inc
• Family First Domestic & Family Counseling Clinic

• Medical Specialty Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Medical Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; 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.