Davenport Medical Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

DAVENPORT MEDICAL INC

Practice address

1023 Mapleton Ave
Oak Park, IL 60302-1405

Phone

(773) 543-8964

NPI assigned

Jul 28, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Tracey Davenport, MDNPI 1114033826

Title

President/Authorized Official

Phone

(773) 543-8964

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracey M Davenport, M.D.

  • Internal Medicine Physician
  • Lincolnwood, IL
  • NPI 1114033826
  Medicare reassignment Care Compare group NPD Authorized official
• Constance Anne Catellani, M.D.

  • Internal Medicine Physician
  • Skokie, IL
  • NPI 1043351745
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658966400000",
    "number": "1619603065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 MAPLETON AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021405",
            "telephone_number": "773-543-8964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 MAPLETON AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021405",
            "telephone_number": "773-543-8964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "PRESIDENT/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "773-543-8964",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036114303",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.practicefusion.com",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "www.practicefusion.com",
            "address_1": "1023 Mapleton Ave",
            "city": "Oak Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "603021405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tawanna L Daniels, LCPC
• Christine Dankha
• Mary Andree Darnall, MS OTR/L
• Anna Lou Dassinger
• Datta Sambare MD SC
• David R Schatz MD SC
• Robert Emmett Davies III, LCSW
• Davis Chiropractic, LTD
• Bertha Davis, LCSW
• Charles Edward Davis, PH.D.

• Internal Medicine Physician in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.