Adventist Health Partners, Inc
Organization Active NPI Internal Medicine Physician · Countryside, IL
NPI 1366487936 · NPPES record last updated Jun 12, 2017
Key facts
- NPI
- 1366487936
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- ADVENTIST HEALTH PARTNERS, INC
- Practice address
- 6438 Joliet Rd
Countryside, IL 60525-4685 - Phone
- (708) 352-5222
- Fax
- (708) 352-5285
- NPI assigned
- Jun 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Ruby Mann
- Title
- Director of Managed Care
- Phone
- (630) 856-6884
Practitioners 1
-
Eric Yang, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1053417 | Adult Medicine Physicians | Certificate of waiver | Apr 24, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040127000064 | IL | Part B Supplier - Clinic/Group Practice | 0244135762 |
Receives reassigned benefits from 392 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Gerontology Nurse Practitioner |
363LG0600X |
Addresses
Primary practice location
6438 Joliet Rd
Countryside, IL 60525-4685
Mailing address
6438 Joliet Rd
Countryside, IL 60525-4685
Phone (708) 352-5222
Other names
- ADULT MEDICINE PHYSICIANS OF COUNTRYSIDE
Other providers in Countryside, IL
- Accelerated Rehabilitation Center of Kenosha LTD
- Hannah Adams
- Advantage Home Medical Equipment, Inc
- Akeru Therapy PLLC
- Michele M Alberts
- Allison Marie Alexander
- All Star Pediatrics, P.C.
- Allbest Home Health Care Inc
All providers in Countryside, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.