Active NPI
Trish L. Palmer, M.D.
- Sports Medicine (Family Medicine) Physician
- Chicago, IL
National Provider Identifier
1750360434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 036096275
- Practice address
- 1611 W Harrison
Suite 400
Chicago, IL 60612 - Phone
- (312) 243-4244
- Fax
- (312) 942-1517
- NPI assigned
- Jan 11, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 036096275 | IL | Primary |
Addresses
Primary practice location
1611 W Harrison
Suite 400
Chicago, IL 60612
Mailing address
1 Westbrook Corporate Ctr
#240
Westchester, IL 60154-5701
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5647658 | Other | IL | AETNA ID# |
| 036096275 1 | Medicaid | IL | |
| 207067 | Other | IL | MEDICARE PTAN LOCALITY 16 |
| 207073 | Other | IL | MEDICARE PTAN LOCALITY 15 |
| P00295720 | Other | IL | RR MEDICARE ID# |
| 1633878 | Other | IL | BCBS GROUP ID# |
| DA4902 | Other | IL | RR MEDICARE PTAN# |
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 |
|---|---|---|---|
| 036096275 | IL | MD | Sports Medicine (Family Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Primary Care Sports Med | Sports Medicine | Past | Accepting new patients |
| Midwest Orthopaedics at Rush, LLC | 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 and National Provider Directory roles.
-
- Orthopaedic Surgery Physician
- Chicago, IL
- NPI 1811942451
-
- Sports Medicine (Family Medicine) Physician
- Salt Lake City, UT
- NPI 1699796706
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260144000000",
"number": "1750360434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 WESTBROOK CORPORATE CTR",
"address_2": "#240",
"city": "WESTCHESTER",
"state": "IL",
"postal_code": "601545701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 W HARRISON",
"address_2": "SUITE 400",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60612",
"telephone_number": "312-243-4244",
"fax_number": "312-942-1517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALMER",
"first_name": "TRISH",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-11",
"last_updated": "2009-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "IL",
"license": "036096275",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA ID#",
"identifier": "5647658",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036096275 1",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN LOCALITY 16",
"identifier": "207067",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN LOCALITY 15",
"identifier": "207073",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE ID#",
"identifier": "P00295720",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GROUP ID#",
"identifier": "1633878",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PTAN#",
"identifier": "DA4902",
"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 Dec 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.