Elizalde Healthcare SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ELIZALDE HEALTHCARE SC

Doing business as

Woundcare VIP

Practice address

1508 Bloomingdale Rd
Glendale Heights, IL 60139-2757

Phone

(630) 915-2037

NPI assigned

Sep 5, 2024

Last updated

Sep 5, 2024By 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

Marnella Elizalde, NPNPI 1184275448

Title

Medical Director

Phone

(630) 915-2037

Specialties & licenses 1

Addresses

Other names 1

• Woundcare VIP Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

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.

• Marnella Elizalde, NP-C

  • Family Nurse Practitioner
  • Bloomingdale, IL
  • NPI 1184275448
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1725494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1710712070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 BLOOMINGDALE RD",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601392757",
            "telephone_number": "630-915-2037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 BLOOMINGDALE RD",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601392757",
            "telephone_number": "630-915-2037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZALDE HEALTHCARE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-05",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "ELIZALDE",
        "authorized_official_first_name": "MARNELLA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "630-915-2037",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woundcare VIP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Glendale Heights, IL
• Providers in Glendale Heights, 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 Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.