Active NPI
Jack D Clemis, M.D.
- Otology & Neurotology Physician
- Chicago, IL
National Provider Identifier
1740272483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otology & Neurotology Physician
- License
- 036-038421
- Practice address
- 151 N Michigan Ave
#914
Chicago, IL 60601-7506 - Phone
- (312) 938-4327
- Fax
- (312) 938-0490
- NPI assigned
- Aug 18, 2005
- Reactivated
- Apr 5, 2006
- Last updated
- Feb 13, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otology & Neurotology Physician | 207YX0901X | 036-038421 | IL | Primary |
Addresses
Primary practice location
151 N Michigan Ave
#914
Chicago, IL 60601-7506
Mailing address
151 N Michigan Ave
#914
Chicago, IL 60601-7506
Phone (312) 938-4327
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1604366 | Other | IL | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-038421 | IL | MD | Otology & Neurotology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwestern Medical Faculty Foundation | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Specialist
- Chicago, IL
- NPI 1851434658
-
dba Northwestern Medical Group
- Durable Medical Equipment & Medical Supplies
- Chicago, IL
- NPI 1417718479
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360713600000",
"number": "1740272483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 N MICHIGAN AVE",
"address_2": "#914",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606017506",
"telephone_number": "312-938-4327",
"fax_number": "312-938-0490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 N MICHIGAN AVE",
"address_2": "#914",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606017506",
"telephone_number": "312-938-4327",
"fax_number": "312-938-0490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMIS",
"first_name": "JACK",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-18",
"last_updated": "2013-02-13",
"deactivation_date": "2006-03-21",
"reactivation_date": "2006-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "207YX0901X",
"taxonomy_group": "",
"desc": "Otolaryngology, Otology & Neurotology",
"state": "IL",
"license": "036-038421",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "1604366",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.