NPIMap

Individual provider Active NPI

Christopher Brenner, MD

  • Family Medicine Physician
  • Countryside, IL
National Provider Identifier
1629020102
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036073572 Issued in IL
Practice address
9910 W 55TH St
Countryside, IL 60525-3612
Phone
(708) 352-6166
Fax
(708) 352-3864
NPI assigned
May 16, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 036073572 IL Primary

Addresses

Primary practice location

9910 W 55TH St
Countryside, IL 60525-3612

Mailing address

9910 W 55TH St
Countryside, IL 60525-3612
Phone (708) 352-6166

Other identifiers 1

IdentifierTypeStateIssuer
036073572MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040506001247 IL Practitioner - Family Practice 7810986874 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Colorado School of Medicine, Denver, 1985
Medicare assignment
May accept Medicare assignment
Group practices
Nani Internal Med LLCGroup PAC ID 6901141498, 5 clinicians

Practice addresses (Care Compare)

412 63Rd St
Suite 100
Downers Grove, IL 60516-2000
Phone (331) 775-2783

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036073572ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Midwest Health Family Medicine CurrentSince Jan 1, 2002 Accepting new patients
Nani Internal Med Aco, LLC CurrentSince Nov 17, 2024 Accepting new patients
Nani Internal Med LLC Family Medicine CurrentSince May 1, 2024 Accepting new patients
Adventist Midwest Health Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Nephrology Associates of Northern Illinois, LTD. Past Accepting new patients

Locations

6438 Joliet Rd
Countryside, IL 60525
Phone (708) 352-5222

6438 Joliet Rd
Ste 203
Countryside, IL 60525
Phone (708) 352-5222

412 63rd St
Ste 100
Downers Grove, IL 60516
Phone (331) 775-2783

5201 Willow Springs Rd
La Grange Highlands, IL 60525
Phone (630) 323-5214

5101 Willow Springs Rd
Lagrange Hlds, IL 60525
Phone (708) 245-4073

120 W 22nd St
Oak Brook, IL 60523

2434 Wolf Rd
Westchester, IL 60154
Phone (630) 856-6800

Interoperability endpoints

  • Direct secure messaging: christopher.brenner.1@18778.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/18778/brand/1/csg/1/fhir/r4

Organizations & group practices 7

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 11

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629020102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9910 W 55TH ST",
            "city": "COUNTRYSIDE",
            "state": "IL",
            "postal_code": "605253612",
            "telephone_number": "708-352-6166",
            "fax_number": "708-352-3864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9910 W 55TH ST",
            "city": "COUNTRYSIDE",
            "state": "IL",
            "postal_code": "605253612",
            "telephone_number": "708-352-6166",
            "fax_number": "708-352-3864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNER",
        "first_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036073572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036073572",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Countryside, IL

Sources for this page

Verify at the official NPI Registry.