Prairie Glen Primary Care, P.C.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036110756 Issued in IL

Legal business name

PRAIRIE GLEN PRIMARY CARE, P.C.

Practice address

15505 127TH St
Lemont, IL 60439-4433

Phone

(630) 257-5400

Fax

(630) 257-1954

NPI assigned

Jan 2, 2007

Organization subpart

No

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

Authorized official

Name

Ilah Marie Heller-Bair, MD

Title

Owner

Phone

(630) 257-5400

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317081600000",
    "number": "1851458699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15505 127TH ST",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604394433",
            "telephone_number": "630-257-5400",
            "fax_number": "630-257-1954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15505 127TH ST",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604394433",
            "telephone_number": "630-257-5400",
            "fax_number": "630-257-1954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE GLEN PRIMARY CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2011-09-27",
        "status": "A",
        "authorized_official_last_name": "HELLER-BAIR",
        "authorized_official_first_name": "ILAH",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-257-5400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036110756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6599328",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD O",
            "identifier": "01634883",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110756",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SILVER CROSS MANAGED CARE",
            "identifier": "276",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5936374",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Polish American Medical Center LTD
• Allison Popek, RBT
• Kenneth Porter, MD
• Bethany Potempa, PMHNP
• William H Powers, PHARM.D.
• Premier Surgical Assistants
• Qi Wellness Clinic Inc
• Kara Randall, FNP-C
• Reclaim Therapy LLC
• Krishnakanth G Reddy, PHARMD

• Primary Care Clinic/Center in Lemont, IL
• Providers in Lemont, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; 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.