Individual provider Active NPI

Debra Beth Stulberg, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1689774283
Registry record updated Jun 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-112006 Issued in IL
Practice address
5843 S Western Ave
Chicago, IL 60636-1526
Phone
(773) 434-8600
NPI assigned
Sep 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2013

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 036-112006 IL Primary

Addresses

Primary practice location

5843 S Western Ave
Chicago, IL 60636-1526

Mailing address

5841 S Maryland Ave # Mc7110
Chicago, IL 60637-1447
Phone (773) 834-1356

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070720000636 IL Practitioner - Family Practice 3870694813 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Harvard Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Friend Family Health Center IncGroup PAC ID 2062494552, 36 clinicians

Practice addresses (Care Compare)

5843 S Western Ave
Chicago, IL 60636-1526
Phone (773) 434-8600

6250 S Cottage Grove Ave
Chicago, IL 60637-2530
Phone (773) 702-0660

Hospital & facility affiliations

  • The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-112006ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County Current Accepting new patients
Cook County Family Medicine CurrentSince Sep 23, 2013 Accepting new patients
Friend Family Health Center Inc CurrentSince Jul 31, 2013 Accepting new patients
Friend Family Health Center Inc CurrentSince Jul 31, 2013 Accepting new patients
Cook County CurrentSince Sep 23, 2013 Accepting new patients
Friend Family Health Center Inc Current Accepting new patients
Friend Family Health Center, Inc Past Accepting new patients

Locations

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1900 W Polk St
#1200
Chicago, IL 60612
Phone (312) 864-0917

1522 E 63rd St
Chicago, IL 60637
Phone (773) 795-2260

5843 S Western Ave
Chicago, IL 60636
Phone (773) 434-8600

800 E 55th St
Chicago, IL 60615
Phone (773) 702-2193

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372291200000",
    "number": "1689774283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE # MC7110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371447",
            "telephone_number": "773-834-1356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5843 S WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606361526",
            "telephone_number": "773-434-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STULBERG",
        "first_name": "DEBRA",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2013-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-112006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.