Salaam Community Wellness Center

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

Legal business name

SALAAM COMMUNITY WELLNESS CENTER

Practice address

613 E 67TH St
Chicago, IL 60637-4122

Phone

(773) 207-3540

NPI assigned

May 7, 2021

Last updated

May 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Constance Diane Shabazz, MD

Title

Ceo

Phone

(773) 330-4115

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

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.

• Audrey Lynn Tanksley, MD

  • Internal Medicine Physician
  • Evergreen Park, IL
  • NPI 1750524518
  Medicare reassignment NPD
• Patrice Muhammad, PA-C

  • Physician Assistant
  • Chicago, IL
  • NPI 1427062298
  NPD
• Cornelius Rogers, M.D.

  • Internal Medicine Physician
  • South Holland, IL
  • NPI 1285644591
  NPD

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

{
    "created_epoch": "1620345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651536000000",
    "number": "1376127225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18613 JANA PATRICE DR",
            "city": "PFLUGERVILLE",
            "state": "TX",
            "postal_code": "786607584",
            "telephone_number": "773-330-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 E 67TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606374122",
            "telephone_number": "773-207-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALAAM COMMUNITY WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-07",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A",
        "authorized_official_last_name": "SHABAZZ",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-330-4115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Somchart Sakulkoo, BCBA
• Jirasan Sakulsom, O.D.
• Atsushi Sakuraba, MD
• Sal Child Services Inc.
• Marc Andrew Sala, MD
• Salaam Consultant and Reentry Firm LLC
• Tony Faseeh Salaam, LCSW
• Narasimha Ramprasad Saladi, M.D
• Nikita Saladi
• Assia Salah, MD

• Addiction Medicine (Internal Medicine) Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Addiction Medicine (Internal Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; 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.