Johann Sebastian JC Reyes Serag, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-141804 Issued in IL

Practice address

2720 Divison St
Chicago, IL 60622-2853

Phone

(773) 523-8600

NPI assigned

Sep 17, 2009

Last updated

Sep 24, 2018By 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 2

Addresses

Other identifiers 2

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

Specialty

Family Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premise Health of Illinois Medical PCGroup PAC ID 3971764762, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Premise Health of Illinois Medical PC

  dba Mount Vernon Health Center Mt Vernon

  • Primary Care Clinic/Center
  • Mount Vernon, IL
  • NPI 1427366921
  Medicare reassignment Care Compare group NPD
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Des Plaines, IL
  • NPI 1982783692
  Medicare reassignment NPD
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1134290570
  NPD
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1699701383
  NPD
• Premise Health of Illinois Medical PC

  dba MCL Health Center - Utica

  • Multi-Specialty Clinic/Center
  • Utica, IL
  • NPI 1295518868
  NPD
• Premise Health of Illinois Medical PC

  dba Premise Health Wellness Center

  • Multi-Specialty Clinic/Center
  • Northbrook, IL
  • NPI 1629716121
  NPD

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

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537747200000",
    "number": "1487987814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3603",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605223603",
            "telephone_number": "773-772-7858",
            "fax_number": "773-276-6668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 DIVISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222853",
            "telephone_number": "773-523-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERAG",
        "first_name": "JOHANN SEBASTIAN JC",
        "middle_name": "REYES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-17",
        "last_updated": "2018-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD446474",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-141804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12464493",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036141804",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ser Es Mental Health Services, PLLC
• Ferdinand Artuz Sera Jose
• Abigail Serafin, MSW, LSW (PENDING)
• Anna Serafini
• Evelyn Grace Nartatez Serag, MD
• Jere Robert Seralde, DDS
• Alexa Serao, LPC
• Seraphic Home Health LLC
• Amy Seraphin
• Consuelo Serbia, LPC, MACP

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.