Centegra Primary Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CENTEGRA PRIMARY CARE, LLC

Doing business as

Centegra Physician 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

Last updated

Mar 21, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Tomlinson

Title

Cio & Cfo

Phone

(815) 788-5831

Specialties & licenses 10

Addresses

Other names 1

• Centegra Physician Care, LLC Doing business as

Locations

Practitioners 63

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.

• Marietta P Abraham, MD

  • Family Medicine Physician
  • Huntley, IL
  • NPI 1376583658
  NPD (past)
• Kimberly D Ackert, PA-C

  • Physician Assistant
  • McHenry, IL
  • NPI 1538172739
  NPD (past)
• S Jameel Ali, M.D.

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1427254499
  NPD (past)
• Barbara E Amsler, M.D.

  • Internal Medicine Physician
  • Algonquin, IL
  • NPI 1356351258
  NPD (past)
• Nikolas J. Antoniou, M.D.

  • Family Medicine Physician
  • Gurnee, IL
  • NPI 1487683793
  NPD (past)
• Deborah L Bailey, PA-C

  • Physician Assistant
  • McHenry, IL
  • NPI 1942632567
  NPD (past)
• Brenda Bergeson, MD

  • Family Medicine Physician
  • Bartlett, IL
  • NPI 1144258542
  NPD (past)
• Christine Pabin Bishof, MD

  • Emergency Medicine Physician
  • Blue Island, IL
  • NPI 1992923288
  NPD (past)
• Nuzhat Chalisa, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Channahon, IL
  • NPI 1184686909
  NPD (past)
• Tao Chen, M.D.

  • Gynecology Physician
  • Woodstock, IL
  • NPI 1114975232
  NPD (past)
• Christine D'Onofrio

  • Pediatric Nurse Practitioner
  • Huntley, IL
  • NPI 1659477842

  Pediatrics

  NPD (past)
• Philippa M Devenney, M.D.

  • Internal Medicine Physician
  • Dixon, IL
  • NPI 1518189083
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395360000000",
    "number": "1700905205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13707 W JACKSON ST",
            "address_2": "CENTEGRA PRIMARY CARE, LLC",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600980000",
            "telephone_number": "815-206-1060",
            "fax_number": "815-338-6297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13707 W JACKSON ST",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600983188",
            "telephone_number": "815-337-2890",
            "fax_number": "815-338-6297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTEGRA PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2014-03-21",
        "status": "A",
        "authorized_official_last_name": "TOMLINSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CIO & CFO",
        "authorized_official_telephone_number": "815-788-5831"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centegra Physician Care, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eliana Maria Carbajal, LPC
• Juan Carbajal
• Miguel A Carbajal
• Hannah Carlson
• Shelly R Cartwright, CNP
• Joellen Sedlack Channon, M.D.
• Charlene Shephard PLLC
• Cynthia Charoenying, RPH
• Beck W Chase, DPT
• Tao Chen, M.D.

• Family Medicine Physician in Woodstock, IL
• Providers in Woodstock, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; 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.