Summit Medical Center S.C.
Organization Active NPI Primary Care Clinic/Center · Summit, IL
NPI 1679744643 · NPPES record last updated Aug 29, 2022
Key facts
- NPI
- 1679744643
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 036086195 (IL)
- Legal business name
- SUMMIT MEDICAL CENTER S.C.
- Practice address
- 6252 S Archer Rd
Summit, IL 60501-1720 - Phone
- (708) 496-9549
- Fax
- (708) 728-9429
- NPI assigned
- Mar 18, 2008
- Organization subpart
- No
Authorized official
- Name
- Ankit Shah, MD
- Title
- President
- Phone
- (708) 496-9549
Practitioners 3
-
Ankit Kirit Shah, MD
-
Angelina D Ledonne, MS,APRN BC
-
Kirit C Shah, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1005753 | Summit Medical Center | Certificate of waiver | Oct 29, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091106000514 | IL | Part B Supplier - Clinic/Group Practice | 6406994755 |
Receives reassigned benefits from 3 practitioners Practice locations: Summit, IL |
National Provider Directory
Locations
6252 S Archer Rd
Summit Argo, IL 60501
Phone (708) 496-9549
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 036086195 | IL | Yes |
Addresses
Primary practice location
6252 S Archer Rd
Summit, IL 60501-1720
Mailing address
6252 S Archer Rd
Summit, IL 60501-1720
Phone (708) 496-9549
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036086195 | Medicaid | IL |
Other names
- Summit Medical Center
Other providers in Summit, IL
- Nazeer Shaik
- Benjamin Silva
- Valerie L Stout
- Summit Behavioral Health
- Summit Dental Center LLC
- Summit Medical Pharmacy Inc
- Summit SCH Dist 104
- Janice L Synowiecki
- Susan M Tracy
- Village of Summit
All providers in Summit, IL · Primary Care Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.