4D Healthware, LLC

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

036-094623 Issued in IL

Legal business name

4D HEALTHWARE, LLC

Doing business as

4D Healthware LLC Clinical Consortium

Practice address

401 N Michigan Ave Ste 1740
Chicago, IL 60611-4742

Phone

(224) 633-9472

Fax

(630) 857-9069

NPI assigned

Jul 20, 2018

Last updated

Jun 11, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

4D HEALTHWARE, LLCAs reported in NPPES

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

Authorized official

Name

Star Cunningham

Title

Founder/Ceo

Phone

(847) 650-7827

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• 4D HEALTHWARE LLC CLINICAL CONSORTIUM Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Part of

4D Healthware LLC

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.

• Shammona Clark, FNP-C

  • Family Nurse Practitioner
  • Chicago, IL
  • NPI 1235785809
  Medicare reassignment Care Compare group NPD
• Thom E. Lobe, MD

  • Pediatric Surgery Physician
  • Chicago, IL
  • NPI 1376525550
  Medicare reassignment Care Compare group NPD
• Ronald E Sam, D.O.

  • Internal Medicine Physician
  • Oak Lawn, IL
  • NPI 1073537643
  Medicare reassignment

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

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1407333685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N MICHIGAN AVE STE 1740",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114742",
            "telephone_number": "224-633-9472",
            "fax_number": "630-857-9069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N MICHIGAN AVE STE 1740",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114742",
            "telephone_number": "224-633-9472",
            "fax_number": "630-857-9069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4D HEALTHWARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "4D HEALTHWARE, LLC",
        "enumeration_date": "2018-07-20",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "STAR",
        "authorized_official_title_or_position": "FOUNDER/CEO",
        "authorized_official_telephone_number": "847-650-7827"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "IL",
            "license": "036-094623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIONAL OPT OUT",
            "identifier": "OPTIONAL",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "4D HEALTHWARE LLC CLINICAL CONSORTIUM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "4D HEALTHWARE LLC CLINICAL CONSORTIUM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Case Manager/Care Coordinator in Chicago, IL
• Providers in Chicago, IL by specialty
• Case Manager/Care Coordinator in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.