Centegra Primary Care, LLC
Organization Active NPI Family Medicine Physician · Woodstock, IL
NPI 1700905205 · NPPES record last updated Mar 21, 2014
Key facts
- NPI
- 1700905205
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CENTEGRA PRIMARY CARE, LLC
- Practice address
- 13707 W Jackson St
Woodstock, IL 60098-3188 - Phone
- (815) 337-2890
- Fax
- (815) 338-6297
- NPI assigned
- Mar 28, 2007
- Organization subpart
- No
Authorized official
- Name
- David Tomlinson
- Title
- Cio & Cfo
- Phone
- (815) 788-5831
Practitioners 63
-
Kimberly D Ackert, PA-C
-
S Jameel Ali, M.D.
-
Barbara E Amsler, M.D.
-
Nikolas J. Antoniou, M.D.
-
Deborah L Bailey, PA-C
-
Brenda Bergeson, MD
-
Nuzhat Chalisa, MD
-
Tao Chen, M.D.
-
Philippa M Devenney, M.D.
-
Jamie Gancayco, MD
-
Carol A Gilmore, MD
-
Stephanie H Goede, PA-C
-
Asad Jamal, M.D.
-
Lillie Larsen, REGISTERED DIETICIAN
-
Yanbing Li, M.D.
-
Pin Lin, MD
-
Roger Alan Lundquist, M.D.
-
Hiralal Maheshwari, M.D., PHD
National Provider Directory
Locations
935 Skidmore Dr
Antioch, IL 60002
Phone (847) 313-1435
13707 W Jackson St
Woodstock, IL 60098
Phone (312) 942-5939
13707 W Jackson St
#7412
Woodstock, IL 60098
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Endocrinology, Diabetes & Metabolism Physician |
207RE0101X | |||
| Rheumatology Physician |
207RR0500X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Pediatrics Physician |
208000000X | |||
| Nurse Practitioner |
363L00000X | |||
| Adult Health Nurse Practitioner |
363LA2200X | |||
| Family Nurse Practitioner |
363LF0000X | |||
| Pediatric Nurse Practitioner |
363LP0200X |
Addresses
Primary practice location
13707 W Jackson St
Woodstock, IL 60098-3188
Mailing address
13707 W Jackson St
Centegra Primary Care, LLC
Woodstock, IL 60098-0000
Phone (815) 206-1060
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CC7412 | Other | IL | MEDICARE RAILROAD |
| 209584 | Other | IL | MEDICARE GROUP |
Other names
- Centegra Physician Care, LLC
Other providers in Woodstock, IL
- Eliana Maria Carbajal
- Juan Carbajal
- Miguel A Carbajal
- Hannah Carlson
- Shelly R Cartwright
- Joellen Sedlack Channon
- Charlene Shephard PLLC
- Cynthia Charoenying
- Beck W Chase
- Tao Chen
All providers in Woodstock, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.