NPIMap

Organization Active NPI

Informe Healthcare Il LLC

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1639790678
Registry record updated Apr 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INFORME HEALTHCARE IL LLC
Practice address
11401 S Oakley Ave
Chicago, IL 60643-4196
Phone
(773) 233-6311
Fax
(773) 945-0591
NPI assigned
Apr 30, 2020
Last updated
Apr 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2020

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

Authorized official

Name
Jodi CzernejewskiNPI 1982969812
Title
Ceo
Phone
(414) 242-5468

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Internal Medicine Physician 207R00000X NU Primary
Hospitalist Physician 208M00000X NU
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X NU

Addresses

Primary practice location

11401 S Oakley Ave
Chicago, IL 60643-4196

Mailing address

2741 W Layton Ave Ste 106
Milwaukee, WI 53221-2600
Phone (414) 242-5468

Other practice location 1

2741 W Layton Ave Ste 106
Milwaukee, WI 53221-2600
Phone (414) 242-5468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI, KS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20201020002277 IL Part B Supplier - Clinic/Group Practice 8123448784 Receives reassigned benefits from 2 practitioners
Practice locations: Rockford, IL
O20231031001630 WI Part B Supplier - Clinic/Group Practice 8123448784 Receives reassigned benefits from 22 practitioners
Practice locations: Brookfield, WI; Thiensville, WI; Milwaukee, WI; Madison, WI; Kenosha, WI
O20240111000572 KS Part B Supplier - Clinic/Group Practice 8123448784 Receives reassigned benefits from 8 practitioners
Practice locations: Elwood, KS

National Provider Directory

National Provider Directory

Locations

11401 S Oakley Ave
Chicago, IL 60643
Phone (733) 233-6311

8800 Virginia Pl
#I
Merrillville, IN 46410
Phone (219) 733-1370

2741 W Layton Ave
Ste 106
Milwaukee, WI 53221

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1588204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1639790678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2741 W LAYTON AVE STE 106",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532212600",
            "telephone_number": "414-242-5468",
            "fax_number": "888-724-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11401 S OAKLEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606434196",
            "telephone_number": "773-233-6311",
            "fax_number": "773-945-0591"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2741 W Layton Ave Ste 106",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532212600",
            "country_code": "US",
            "telephone_number": "414-242-5468",
            "fax_number": "888-724-0875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INFORME HEALTHCARE IL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-30",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "CZERNEJEWSKI",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "414-242-5468"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 30, 2020; 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.