Active NPI
Resurrection Services
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1780954263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- RESURRECTION SERVICES
- Practice address
- 3048 N Harlem Ave
Chicago, IL 60634-5276 - Phone
- (773) 237-7795
- Fax
- (773) 237-7547
- NPI assigned
- Dec 30, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Daniel MC Cormick
- Title
- Sr. Vice President
- Phone
- (708) 583-6817
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
3048 N Harlem Ave
Chicago, IL 60634-5276
Mailing address
PO Box 564437
Chicago, IL 60656-4437
Phone (708) 583-7310
Other names 1
- RMG MARIO SALAZAR
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050215000965 | IL | Part B Supplier - Clinic/Group Practice | 2860396769 |
Receives reassigned benefits from 128 practitioners 47 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
Other NPIs on the same Medicare enrollment 46
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Orthopaedic Surgery Physician
- Chicago, IL
- NPI 1336428101
O20050215000965
-
- Emergency Medicine Physician
- Chicago, IL
- NPI 1417252909
O20050215000965
-
- Family Medicine Physician
- Park Ridge, IL
- NPI 1518074608
O20050215000965
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325203200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1325203200000",
"number": "1780954263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 564437",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606564437",
"telephone_number": "708-583-7310",
"fax_number": "708-583-9870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3048 N HARLEM AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606345276",
"telephone_number": "773-237-7795",
"fax_number": "773-237-7547"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RESURRECTION SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2011-12-30",
"last_updated": "2011-12-30",
"status": "A",
"authorized_official_last_name": "MC CORMICK",
"authorized_official_first_name": "DANIEL",
"authorized_official_title_or_position": "SR. VICE PRESIDENT",
"authorized_official_telephone_number": "708-583-6817"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "RMG MARIO SALAZAR",
"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 Dec 30, 2011; 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.