Organization Active NPI

Agape Family Wound Care LLC

  • Medical Physician Assistant
  • Chicago, IL
National Provider Identifier
1770362196
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Legal business name
AGAPE FAMILY WOUND CARE LLC
Practice address
4001 W Devon Ave Ste 210
Chicago, IL 60646-4537
Phone
(773) 983-6204
NPI assigned
Sep 25, 2023
Last updated
May 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Abdul Moghni
Title
President
Phone
(773) 983-6204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU Primary

Addresses

Primary practice location

4001 W Devon Ave Ste 210
Chicago, IL 60646-4537

Mailing address

5800 S Park Ave
Morton Grove, IL 60053-3021
Phone (773) 983-6204

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240111002365 IL Part B Supplier - Clinic/Group Practice 7810348026 Receives reassigned benefits from 1 practitioner
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1770362196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 S PARK AVE",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600533021",
            "telephone_number": "773-983-6204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 W DEVON AVE STE 210",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606464537",
            "telephone_number": "773-983-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAPE FAMILY WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-25",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A",
        "authorized_official_last_name": "MOGHNI",
        "authorized_official_first_name": "ABDUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-983-6204"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 May 30, 2025; 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.