NPIMap

Organization Active NPI

Wise Health Professional Corporation

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1417100157
Registry record updated Nov 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036091776 Issued in IL
Legal business name
WISE HEALTH PROFESSIONAL CORPORATION
Practice address
4755 N Kenmore Ave
Chicago, IL 60640-5015
Phone
(773) 989-9868
NPI assigned
Oct 28, 2008
Last updated
Nov 12, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2009

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

Authorized official

Name
Dr. Shephali Patel, MDNPI 1063592095
Title
Chief Operating Officer
Phone
(847) 322-9602

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036091776 IL Primary

Addresses

Primary practice location

4755 N Kenmore Ave
Chicago, IL 60640-5015

Mailing address

2600 Wynncrest Dr
Long Grove, IL 60047-5033
Phone (847) 322-9602

Other identifiers 2

IdentifierTypeStateIssuer
036091776MedicaidIL
01637603OtherILBLUE CROSS/BLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
Wise Health Professional Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4755 N Kenmore Ave
Chicago, IL 60640
Phone (773) 484-6672

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257984000000",
    "number": "1417100157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 WYNNCREST DR",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "600475033",
            "telephone_number": "847-322-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 N KENMORE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405015",
            "telephone_number": "773-989-9868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE HEALTH PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2009-11-12",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "SHEPHALI",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "847-322-9602",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036091776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036091776",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "01637603",
            "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 Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.