Organization Active NPI

Gabisa Medical Chicago PLLC

  • Community Health Clinic/Center
  • Chicago, IL
National Provider Identifier
1821765140
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
GABISA MEDICAL CHICAGO PLLC
Practice address
4121 W North Ave
Chicago, IL 60639-5205
Phone
(773) 697-8623
Fax
(888) 929-2371
NPI assigned
Aug 25, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Authorized official

Name
Marcelo Venegas-Pizarro, MD
Title
Medical Director
Phone
(347) 524-1914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

4121 W North Ave
Chicago, IL 60639-5205

Mailing address

3436 Clinton Ave
Berwyn, IL 60402-3322
Phone (347) 524-1914

National Provider Directory

National Provider Directory
Tax ID family
Gabisa Medical Chicago PLLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4121 W North Ave
Chicago, IL 60639
Phone (773) 697-8623

NPI Registry JSON

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1821765140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3436 CLINTON AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023322",
            "telephone_number": "347-524-1914",
            "fax_number": "888-929-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606395205",
            "telephone_number": "773-697-8623",
            "fax_number": "888-929-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GABISA MEDICAL CHICAGO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "VENEGAS-PIZARRO",
        "authorized_official_first_name": "MARCELO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "347-524-1914",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "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 Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.