Individual provider Active NPI

Jim A. Christoforidis, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1578546222
Registry record updated Jun 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036103428 Issued in IL
Practice address
4235 W North Ave
Chicago, IL 60639-4852
Phone
(773) 278-6868
Fax
(773) 278-6922
NPI assigned
Nov 28, 2005
Last updated
Jun 3, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2009

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 036103428 IL Primary

Addresses

Primary practice location

4235 W North Ave
Chicago, IL 60639-4852

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
036103428MedicaidIL

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
I20100726000108 IL Practitioner - Family PracticePractitioner - Obstetrics/Gynecology 2062544117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Obstetrics/Gynecology
Education
Northeastern Ohio University College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primecare Community Health, Inc.Group PAC ID 6204722077, 41 clinicians

Practice addresses (Care Compare)

1431 N Western Ave
Suite 401
Chicago, IL 60622-1797
Phone (312) 491-5495

1431 N Western Ave
Suite 406
Chicago, IL 60622-1774
Phone (312) 491-5495

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Primecare Community Health, Inc. Family Medicine Current Accepting new patients
Primecare Community Health, Inc. Family Medicine CurrentSince Dec 14, 2000 Accepting new patients
Primecare Community Health Inc CurrentSince Dec 14, 2000 Accepting new patients
Primecare Community Health Inc Past Accepting new patients

Locations

1127 N Oakley Blvd
Fl 2
Chicago, IL 60622
Phone (312) 633-5841

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

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

4235 W North Ave
Chicago, IL 60639
Phone (773) 276-3360

Interoperability endpoints

  • Direct secure messaging: jim.christoforidis.1@16494.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243987200000",
    "number": "1578546222",
    "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": "312-491-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606394852",
            "telephone_number": "773-278-6868",
            "fax_number": "773-278-6922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTOFORIDIS",
        "first_name": "JIM",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2009-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036103428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036103428",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.