Forum Extended Care SVC Inc II

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

054017240 Issued in IL

Legal business name

FORUM EXTENDED CARE SVC INC II

Practice address

4201 W Victoria St
Chicago, IL 60646-6700

Phone

(847) 673-8727

Fax

(847) 673-6215

NPI assigned

May 13, 2006

Organization subpart

No

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

Authorized official

Name

Brian KramerNPI 1134217623

Title

President

Phone

(847) 673-8727

Specialties & licenses 7

Addresses

Other identifiers 4

Other names 1

• FORUM EXTENDED CARE SVC INC II Doing business as

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Forum Extended Care Services of Central Illinois

  • Long Term Care Pharmacy
  • Springfield, IL
  • NPI 1689024036

  Member Of

  NPD member

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian H Kramer, R.PH.

  • Pharmacist
  • Chicago, IL
  • NPI 1134217623
  NPD Authorized official
• Marc Cook, PHARM.D.

  • Geriatric Pharmacist
  • Skokie, IL
  • NPI 1639208077
  NPD (past)

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619049600000",
    "number": "1346291499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 W VICTORIA ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466700",
            "telephone_number": "847-673-8727",
            "fax_number": "847-673-6215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 W VICTORIA ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466700",
            "telephone_number": "847-673-8727",
            "fax_number": "847-673-6215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORUM EXTENDED CARE SVC INC II",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-13",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A",
        "authorized_official_last_name": "KRAMER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-673-8727"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IN",
            "license": "64001297A",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "WI",
            "license": "1204-43",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IL",
            "license": "054017240",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36855933001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33245400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2022130",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201063520 A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FORUM EXTENDED CARE SVC INC II",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FORUM EXTENDED CARE SVC INC II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Fortuna
• John E Fortunato Jr., MD
• Joseph P Fortunato, PSY.D
• Leanna Fortunato, PHD
• Rosemarie Carmel Fortune
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• Forward Homecare LLC
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• Forward Vision, Inc.
• Forward Vision, Inc.

• Long Term Care Pharmacy in Chicago, IL
• Providers in Chicago, IL by specialty
• Long Term Care Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.