Chris Ebert, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

3001A Sixth Street
Great Lakes, IL 60088-5230

Phone

(847) 688-2616

NPI assigned

Dec 17, 2009

Last updated

Dec 17, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261008000000",
    "number": "1467781666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001A SIXTH STREET",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600885230",
            "telephone_number": "847-688-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001A SIXTH STREET",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600885230",
            "telephone_number": "847-688-2616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERT",
        "first_name": "CHRIS",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-17",
        "last_updated": "2009-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandre Derevianko
• Judy Ann Dixon, FNP
• Michael Shawn Donoghue, D.D.S.
• Jimi Michelle Doty, NP
• Adam Robert Dziedzic, P.A.-C
• Alex Dale Ehrlich, D.D.S.
• Theresa Paola Everest, WHNP
• Allison Fedler
• Michael Philip Fee, DDS
• Luis Victor Fernandez

• Independent Duty Corpsman in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Independent Duty Corpsman in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.