NPIMap

Organization Active NPI

Serenity Internal Medicine & Wellness Center

  • Internal Medicine Physician
  • Hazel Crest, IL
National Provider Identifier
1629696679
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SERENITY INTERNAL MEDICINE & WELLNESS CENTER
Practice address
3330 W 177TH St # 2D-1
Hazel Crest, IL 60429-2184
Phone
(773) 234-9662
NPI assigned
Jul 7, 2020
Last updated
Jul 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

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

Authorized official

Name
Christen Tibbs, MDNPI 1518123363
Title
Physician
Phone
(773) 234-9662

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Primary Care Clinic/Center 261QP2300X NU
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

3330 W 177TH St # 2D-1
Hazel Crest, IL 60429-2184

Mailing address

3330 W 177TH St # 2D-1
Hazel Crest, IL 60429-2184

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL contact_us@serenityIM.com

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594080000000",
    "number": "1629696679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 W 177TH ST # 2D-1",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 W 177TH ST # 2D-1",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292184",
            "telephone_number": "773-234-9662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY INTERNAL MEDICINE & WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-07",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A",
        "authorized_official_last_name": "TIBBS",
        "authorized_official_first_name": "CHRISTEN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "773-234-9662",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "contact_us@serenityIM.com",
            "affiliation": "N",
            "address_1": "3330 W 177th St # 2D-1",
            "city": "Hazel Crest",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604292184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hazel Crest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.