NPIMap

Organization Active NPI

Progressive Medical Center SC

  • Internal Medicine Physician
  • Addison, IL
National Provider Identifier
1851464549
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036087152 Issued in IL
Legal business name
PROGRESSIVE MEDICAL CENTER SC
Practice address
1841 W Army Trail Rd
Addison, IL 60101-1901
Phone
(630) 238-9235
Fax
(630) 238-0426
NPI assigned
Nov 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Authorized official

Name
Gabriela Henriquez
Title
Office Manager
Phone
(630) 238-9235

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 036103673 IL
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 036087152 IL Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 036078267 IL

Addresses

Primary practice location

1841 W Army Trail Rd
Addison, IL 60101-1901

Mailing address

229 W Grand Avenue
Suite R
Bensenville, IL 60106-3365
Phone (630) 238-9235

Other identifiers 5

IdentifierTypeStateIssuer
036087152MedicaidIL
036109448MedicaidIL
036103673MedicaidIL
02205538OtherILBCBS GROUP NUMBER
036078267MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819000182 IL Part B Supplier - Clinic/Group Practice 5991778797 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Addison, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
14D0885998Progressive Medical Center1841 W Army Trail Rd, Addison, IL 60101Certificate of waiverJun 24, 2027

National Provider Directory

National Provider Directory

Locations

1841 W Army Trail Rd
Addison, IL 60101
Phone (630) 238-9235

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1851464549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 W GRAND AVENUE",
            "address_2": "SUITE R",
            "city": "BENSENVILLE",
            "state": "IL",
            "postal_code": "601063365",
            "telephone_number": "630-238-9235",
            "fax_number": "630-238-0426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1841 W ARMY TRAIL RD",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601011901",
            "telephone_number": "630-238-9235",
            "fax_number": "630-238-0426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE MEDICAL CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "HENRIQUEZ",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "630-238-9235"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036103673",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036087152",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036078267",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036087152",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036109448",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036103673",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "02205538",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036078267",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Addison, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.