PMR Illinois Holding, LLC
Organization Active NPI Specialist · Miami Gardens, FL
NPI 1770038671 · NPPES record last updated Aug 20, 2016
Key facts
- NPI
- 1770038671
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- PMR ILLINOIS HOLDING, LLC
- Practice address
- 1395 NW 167TH St
Miami Gardens, FL 33169-5742 - Phone
- (305) 831-4760
- NPI assigned
- Aug 20, 2016
- Organization subpart
- No
Authorized official
- Name
- Mary Chen
- Title
- Chief Operating Officer
- Phone
- (305) 831-4760
Corporate family (same tax ID) 2
Practitioners 112
-
Angela Martine Bell, M.D.
-
Shavon Davis, NP
-
Manahil Munir, M.D.
-
Michael Louis Radzienda, M.D.
-
Muhammad Ahmed, MD
-
Hani Alsharif, MD
-
Rabia Alvi, MD
-
Fnu Ayesha, MD
-
Yesenia Bahena, M.D.
-
Bhavna Balaney, MD
-
Sanwar Boyal, MD
-
Katrice Marie Brooks, M.D.
-
Angela Maria Cano-Garcia, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220126001647 | IL | Part B Supplier - Clinic/Group Practice | 2062804909 |
Receives reassigned benefits from 78 practitioners Practice locations: Berwyn, IL; Chicago, IL; Dolton, IL; Glenwood, IL; Oak Lawn, IL |
National Provider Directory
- Tax ID family
- PMR Illinois Holding LLC
Locations
6326 Cermak Rd
Berwyn, IL 60402
Phone (708) 303-9234
2734 W 87th St
Chicago, IL 60652
Phone (773) 918-4700
19310 S Halsted St
Glenwood, IL 60425
Phone (708) 300-3132
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes | ||
| Non-Pharmacy Dispensing Site | 332900000X |
Addresses
Primary practice location
1395 NW 167TH St
Miami Gardens, FL 33169-5742
Mailing address
1395 NW 167TH St
Miami Gardens, FL 33169-5742
Phone (305) 831-4760
Other providers in Miami Gardens, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.