Individual provider Active NPI

Frederman Concepcion, M.D.

  • Cardiovascular Disease Physician
  • Chicago, IL
National Provider Identifier
1417181116
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036114474 Issued in IL
Practice address
5140 N California Ave Ste 780
Chicago, IL 60625-7066
Phone
(773) 989-3957
Fax
(773) 989-3971
NPI assigned
May 8, 2009
Last updated
Apr 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036114474 IL Primary

Addresses

Primary practice location

5140 N California Ave Ste 780
Chicago, IL 60625-7066

Mailing address

2740 W Foster Ave
Ste 310
Chicago, IL 60625-3547
Phone (773) 878-8200

Other identifiers 2

IdentifierTypeStateIssuer
406120090OtherPTAN
036114474MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address fconcepcion277169@direct.northshore.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090814000560 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1254485980 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Suite 2218a
Evanston, IL 60201-1700
Phone (847) 503-4222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Jan 1, 2021 Accepting new patients
Endeavor Health Medical Group CurrentSince Jan 1, 2021 Accepting new patients
Swedish Covenant Management Services, Inc. CurrentSince Jan 1, 2013 Accepting new patients
Swedish Covenant Management Services, Inc. Current Accepting new patients
Swedish Covenant Management Services, Inc CurrentSince Jan 1, 2013 Accepting new patients

Locations

2740 W Foster Ave
Ste 310
Chicago, IL 60625

5140 N California Ave
Chicago, IL 60625
Phone (773) 275-8811

5140 N California Ave
Ste 780
Chicago, IL 60625
Phone (773) 784-5140

5145 N California Ave
Chicago, IL 60625
Phone (773) 989-3800

5345 N Sheridan Rd
Chicago, IL 60640
Phone (773) 293-8890

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

Interoperability endpoints

  • Direct secure messaging: fconcepcion277169@direct.northshore.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1241740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1417181116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 W FOSTER AVE",
            "address_2": "STE 310",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253547",
            "telephone_number": "773-878-8200",
            "fax_number": "773-293-4197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE STE 780",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606257066",
            "telephone_number": "773-989-3957",
            "fax_number": "773-989-3971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONCEPCION",
        "first_name": "FREDERMAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-08",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036114474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "406120090",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036114474",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fconcepcion277169@direct.northshore.org",
            "affiliation": "N",
            "address_1": "5140 N California Ave",
            "address_2": "Ste. 780",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606253645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.