NPIMap

Organization Active NPI

Holy Family Medical Clinic

  • Pediatrics Physician
  • Cicero, IL
National Provider Identifier
1689899551
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036067770 Issued in IL
Legal business name
HOLY FAMILY MEDICAL CLINIC
Practice address
4941 W 14TH St
Cicero, IL 60804-1419
Phone
(708) 780-7400
NPI assigned
Apr 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

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

Authorized official

Name
Dr. Edwin PascualNPI 1326159104
Title
M.D
Phone
(708) 780-7400

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 036067770 IL Primary

Addresses

Primary practice location

4941 W 14TH St
Cicero, IL 60804-1419

Mailing address

4941 W 14TH St
Cicero, IL 60804-1419
Phone (708) 780-7400

Other identifiers 2

IdentifierTypeStateIssuer
0031601680OtherILBCBS
036067770MedicaidIL

National Provider Directory

National Provider Directory

Locations

4941 W 14th St
Cicero, IL 60804
Phone (708) 780-7400

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1689899551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4941 W 14TH ST",
            "city": "CICERO",
            "state": "IL",
            "postal_code": "608041419",
            "telephone_number": "708-780-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4941 W 14TH ST",
            "city": "CICERO",
            "state": "IL",
            "postal_code": "608041419",
            "telephone_number": "708-780-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLY FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "PASCUAL",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "M.D",
        "authorized_official_telephone_number": "708-780-7400",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036067770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0031601680",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067770",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cicero, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; 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.