Active NPI
Galilee Medical Center, S.C.
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1497797393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- GALILEE MEDICAL CENTER, S.C.
- Practice address
- 4849 W Fullerton Ave
Chicago, IL 60639-2503 - Phone
- (773) 309-6740
- Fax
- (773) 237-6606
- NPI assigned
- Jun 12, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Naser Rustom, MD
- Title
- President
- Phone
- (773) 237-3500
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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | |||
| Family Medicine Physician | 207Q00000X | Primary | ||
| Internal Medicine Physician | 207R00000X | |||
| Obstetrics & Gynecology Physician | 207V00000X | |||
| Pediatrics Physician | 208000000X |
Addresses
Primary practice location
4849 W Fullerton Ave
Chicago, IL 60639-2503
Mailing address
4903 W Fullerton Ave
Chicago, IL 60639-2548
Phone (773) 237-0755
Other names 1
- Galilee Medical Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040130000817 | IL | Part B Supplier - Clinic/Group Practice | 5395648836 |
Receives reassigned benefits from 6 practitioners Practice locations: Chicago, IL; Orland Park, IL; Elgin, IL |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0993144 | Galilee Medical Center Fullerton | Certificate of waiver | Nov 5, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Galilee Medical Center SC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Practice Physician
- Chicago, IL
- NPI 1437104239
-
- Clinical Medical Laboratory
- Chicago, IL
- NPI 1497493241
Locations
4937 W Fullerton Ave
Chicago, IL 60639
Phone (773) 309-8023
Practitioners & affiliated clinicians
Practitioners 10
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Specialist
- Chicago, IL
- NPI 1952359184
-
- Neurology Physician
- Chicago, IL
- NPI 1851362495
-
- Body Imaging Physician
- Chicago, IL
- NPI 1073541108
-
- Diagnostic Radiology Physician
- Oak Brook, IL
- NPI 1235179409
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1675209600000",
"number": "1497797393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4903 W FULLERTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606392548",
"telephone_number": "773-237-0755",
"fax_number": "773-237-0785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4849 W FULLERTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606392503",
"telephone_number": "773-309-6740",
"fax_number": "773-237-6606"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GALILEE MEDICAL CENTER, S.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-12",
"last_updated": "2023-02-01",
"certification_date": "2023-02-01",
"status": "A",
"authorized_official_last_name": "RUSTOM",
"authorized_official_first_name": "NASER",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "773-237-3500",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Chiropractor",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Galilee Medical Center",
"code": "4",
"type": "Former Legal Business Name"
},
{
"organization_name": "Galilee Medical Center",
"code": "4",
"type": "Former Legal Business Name"
}
]
}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 Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.