Active NPI
St Anthony Emergency Services Physician Group
- Emergency Medical Services (Emergency Medicine) Physician
- Chicago, IL
National Provider Identifier
1760587703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician
- Legal business name
- ST ANTHONY EMERGENCY SERVICES PHYSICIAN GROUP
- Practice address
- 2875 W 19TH St
Chicago, IL 60623-3501 - Phone
- (773) 484-4783
- NPI assigned
- Sep 14, 2006
- Organization subpart
- Yes
- Parent organization
- SAINT ANTHONY HOSPITAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Guy A Medaglia
- Title
- President/Ceo, Authorized Official
- Phone
- (773) 484-1000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | Primary |
Addresses
Primary practice location
2875 W 19TH St
Chicago, IL 60623-3501
Mailing address
2001 S California Ave
Chicago, IL 60608-2486
Phone (773) 484-4783
Other names 1
- St Anthony Emergency Services Physician Group
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041001000476 | IL | Part B Supplier - Clinic/Group Practice | 5698744076 |
Receives reassigned benefits from 33 practitioners Practice locations: Chicago, IL |
National Provider Directory
National Provider Directory- Part of
- St Joseph HLTH Ctr Hosp
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Chicago, IL
- NPI 1861831315
Member Of
Practitioners & affiliated clinicians
Practitioners 34
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Emergency Medicine Physician
- Chicago, IL
- NPI 1851859367
IL, Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1715644800000",
"number": "1760587703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 S CALIFORNIA AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606082486",
"telephone_number": "773-484-4783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2875 W 19TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606233501",
"telephone_number": "773-484-4783"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST ANTHONY EMERGENCY SERVICES PHYSICIAN GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SAINT ANTHONY HOSPITAL",
"enumeration_date": "2006-09-14",
"last_updated": "2024-05-14",
"certification_date": "2024-05-14",
"status": "A",
"authorized_official_last_name": "MEDAGLIA",
"authorized_official_first_name": "GUY",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "PRESIDENT/CEO, AUTHORIZED OFFICIAL",
"authorized_official_telephone_number": "773-484-1000"
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "St Anthony Emergency Services Physician Group",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "St Anthony Emergency Services Physician Group",
"code": "3",
"type": "Doing Business As"
}
]
}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 May 14, 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.