Active NPI
Jack C. Enter Jr., PA-C
- Physician Assistant
- Chicago, IL
National Provider Identifier
1366444184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085-000925
- Practice address
- 4211 N Cicero Ave
Suite 100
Chicago, IL 60641-1651 - Phone
- (773) 794-1000
- Fax
- (773) 794-9986
- NPI assigned
- Aug 11, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085-000925 | IL | Primary |
Addresses
Primary practice location
4211 N Cicero Ave
Suite 100
Chicago, IL 60641-1651
Mailing address
10100 Forest Hills Rd
Machesney Park, IL 61115-8234
Phone (815) 713-2742
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085.000925 | Other | IL | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-000925 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fastrac Medical, P.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- NPI 1659517597
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224201600000",
"number": "1366444184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10100 FOREST HILLS RD",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611158234",
"telephone_number": "815-713-2742",
"fax_number": "815-282-8597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4211 N CICERO AVE",
"address_2": "SUITE 100",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606411651",
"telephone_number": "773-794-1000",
"fax_number": "773-794-9986"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENTER",
"first_name": "JACK",
"middle_name": "C.",
"name_suffix": "Jr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-11",
"last_updated": "2008-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-000925",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "085.000925",
"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 Oct 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.