NPIMap

Organization Active NPI

Providea Health Partners, LLC

Doing business as Family First Medical Group

  • Obstetrics & Gynecology Physician
  • Mokena, IL
National Provider Identifier
1770911208
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
PROVIDEA HEALTH PARTNERS, LLC
Doing business as
Family First Medical Group
Women's Healthcare of Illinois
Practice address
10260 191St St
Suite 100
Mokena, IL 60448-8801
Phone
(708) 572-7606
Fax
(708) 469-4358
NPI assigned
Oct 18, 2013
Last updated
Feb 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Authorized official

Name
Eileen Johnson
Title
Director
Phone
(708) 945-6470

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

10260 191St St
Suite 100
Mokena, IL 60448-8801

Mailing address

10260 191St St
Suite 100
Mokena, IL 60448-8801
Phone (708) 572-7606

Other practice location 1

9730 S Western Ave Ste 700
Evergreen Park, IL 60805-2814
Phone (708) 425-1907

Other names 2

  • Family First Medical Group Doing business as
  • Women's Healthcare of Illinois Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140211000403 IL Part B Supplier - Clinic/Group Practice 5698904878 Receives reassigned benefits from 13 practitioners
Practice locations: Evergreen Park, IL; Mokena, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0944993Providea Health Partners LLC9730 S Western Ave - Ste 700, Evergreen Park, IL 60805Provider-performed microscopyMar 17, 2027
14D1011094Providea Health Partners LLC10260 W 191St St, Ste 100, Mokena, IL 60448Provider-performed microscopyMar 31, 2027

National Provider Directory

National Provider Directory

Locations

9730 S Western Ave
Ste 700
Evergreen Pk, IL 60805
Phone (708) 425-1907

10260 191st St
Ste 100
Mokena, IL 60448
Phone (708) 425-1907

4950 W 95th St
Oak Lawn, IL 60453
Phone (708) 576-8150

9601 165th St
Ste 2
Orland Park, IL 60467
Phone (708) 349-7310

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.70301

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1382054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1770911208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10260 191ST ST",
            "address_2": "SUITE 100",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488801",
            "telephone_number": "708-572-7606",
            "fax_number": "708-469-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10260 191ST ST",
            "address_2": "SUITE 100",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488801",
            "telephone_number": "708-572-7606",
            "fax_number": "708-469-4358"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9730 S Western Ave Ste 700",
            "address_purpose": "LOCATION",
            "city": "Evergreen Park",
            "state": "IL",
            "postal_code": "608052814",
            "country_code": "US",
            "telephone_number": "708-425-1907",
            "fax_number": "708-422-4253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDEA HEALTH PARTNERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-18",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "EILEEN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "708-945-6470"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family First Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Women's Healthcare of Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.