Individual provider Active NPI

Michael H Friedman, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1487638953
Registry record updated Aug 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036080977 Issued in IL
Practice address
1431 N Western Ave
Suite #406
Chicago, IL 60622-1797
Phone
(312) 633-5841
Fax
(312) 491-5020
NPI assigned
Nov 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036080977 IL Primary

Addresses

Primary practice location

1431 N Western Ave
Suite #406
Chicago, IL 60622-1797

Mailing address

1431 N Western Ave
Suite #406
Chicago, IL 60622-1797
Phone (312) 633-5841

Other practice location 1

2233 W Division St
Chicago, IL 60622-8151
Phone (312) 770-2000

Other identifiers 1

IdentifierTypeStateIssuer
036080977MedicaidIL

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
I20040309000874 IL Practitioner - Family Practice 2062300288 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Primecare Community Health, Inc. Family Medicine CurrentSince Sep 1, 1998 Accepting new patients
Primecare Community Health Inc CurrentSince Sep 1, 1998 Accepting new patients
Primecare Community Health, Inc. Family Medicine Current Accepting new patients
Primecare Community Health, Inc. Family Medicine Current Accepting new patients

Locations

1431 N Western Ave
Ste 406
Chicago, IL 60622
Phone (312) 491-5495

1127 N Oakley Blvd
Chicago, IL 60622
Phone (312) 770-2040

1431 N Western Ave
Ste 401
Chicago, IL 60622
Phone (312) 633-5841

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Primecare Community Health, Inc.Chicago, IL, CCN 781922 Federally qualified health center Corporate Director Jan 1, 2024
ElstonChicago, IL, CCN C41028 Federally qualified health center Corporate Director Jan 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565049600000",
    "number": "1487638953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 N WESTERN AVE",
            "address_2": "SUITE #406",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221797",
            "telephone_number": "312-633-5841",
            "fax_number": "312-491-5020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 N WESTERN AVE",
            "address_2": "SUITE #406",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221797",
            "telephone_number": "312-633-5841",
            "fax_number": "312-491-5020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2233 W Division St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606228151",
            "country_code": "US",
            "telephone_number": "312-770-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRIEDMAN",
        "first_name": "MICHAEL",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2019-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036080977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036080977",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.