Individual provider Active NPI

Tessa Qualkinbush

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1841645843
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036149743 Issued in IL
Practice address
2900 N Lake Shore Dr
Chicago, IL 60657-5640
Phone
(773) 665-3000
NPI assigned
Apr 27, 2016
Last updated
Jun 24, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 036149743 IL Primary

Addresses

Primary practice location

2900 N Lake Shore Dr
Chicago, IL 60657-5640

Mailing address

2900 N Lake Shore Dr
Chicago, IL 60657-5640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190628000997 IL Practitioner - Family Practice 2365776093 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Sinai Community FoundationGroup PAC ID 5991600405, 247 clinicians

Practice addresses (Care Compare)

1611 S Cicero Ave
Cicero, IL 60804-1520
Phone (708) 477-4840

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036149743ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Sinai Community Foundation Current Accepting new patients
Mount Sinai Community Foundation Family Medicine CurrentSince Jul 15, 2019 Accepting new patients
Mount Sinai Community Foundation CurrentSince Jul 15, 2019 Accepting new patients

Locations

1501 S California Ave
Chicago, IL 60608
Phone (773) 257-6770

1501 S California Ave
#7140
Chicago, IL 60608
Phone (773) 257-4758

26460 Network Pl
Chicago, IL 60673
Phone (708) 786-2900

1611 S Cicero Ave
Cicero, IL 60804
Phone (312) 405-9030

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561334400000",
    "number": "1841645843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 N LAKE SHORE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 N LAKE SHORE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575640",
            "telephone_number": "773-665-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALKINBUSH",
        "first_name": "TESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-27",
        "last_updated": "2019-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036149743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.