Provida Health Center SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

042616958 Issued in IL

Legal business name

PROVIDA HEALTH CENTER SC

Doing business as

Provida Family Medicine

Practice address

1425 N Hunt Club Rd Ste 100
Gurnee, IL 60031

Phone

(847) 548-2200

Fax

(847) 548-2865

NPI assigned

Jun 22, 2007

Last updated

Jan 31, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Luis I Salazar, MDNPI 1417942822

Title

Authorized Official

Phone

(847) 548-2200

Specialties & licenses 1

Addresses

Other names 1

• Provida Family Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Luis I Salazar, M.D.

  • Family Medicine Physician
  • Gurnee, IL
  • NPI 1417942822
  Medicare reassignment Care Compare group NPD Authorized official
• Ksenia Samvel, PA-C

  • Physician Assistant
  • Gurnee, IL
  • NPI 1952733818
  Medicare reassignment Care Compare group
• Alejandra Camacho, FNP-C

  • Family Nurse Practitioner
  • Gurnee, IL
  • NPI 1891568531
  Medicare reassignment NPD
• Jessie L. Dinelli, NP

  • Family Nurse Practitioner
  • Gurnee, IL
  • NPI 1487343729

  Family Medicine

  Medicare reassignment NPD
• Jocelyn Orellana, FNP-BC

  • Family Nurse Practitioner
  • Gurnee, IL
  • NPI 1700683596
  Medicare reassignment NPD
• Kelly Jean Purcell, PA-C

  • Physician Assistant
  • Gurnee, IL
  • NPI 1689542466
  Medicare reassignment NPD
• Elida Gricelda Trejo, FNP-BC

  • Family Medicine Physician
  • Beach Park, IL
  • NPI 1811777683

  Multi-Specialty

  Medicare reassignment NPD
• Rosalva Acosta, PA-C

  • Medical Physician Assistant
  • Gurnee, IL
  • NPI 1972663466
  Medicare reassignment
• Dominic Alesandrini, PA-C

  • Physician Assistant
  • Gurnee, IL
  • NPI 1700442084
  Medicare reassignment
• Fatima Mustafa Klassman, PA-C

  • Physician Assistant
  • Kildeer, IL
  • NPI 1255716320
  Medicare reassignment
• Blake Michael Rowe, PA-C

  • Physician Assistant
  • Gurnee, IL
  • NPI 1053075325
  Medicare reassignment

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

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1881890333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 N HUNT CLUB RD STE 100",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312632",
            "telephone_number": "847-548-2200",
            "fax_number": "847-548-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 N HUNT CLUB RD STE 100",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "60031",
            "telephone_number": "847-548-2200",
            "fax_number": "847-548-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDA HEALTH CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-22",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "SALAZAR",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "847-548-2200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "042616958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provida Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Procare Dental Group, P.C. (Grand Dentistry)
• Professional Family Solutions LLC
• Michelle Progar, PSYD
• Provena Home Health Inc (Provena Home Health Inc Waukegan)
• Provena Home Health Inc (Provena Home Infusioin Waukegan)
• Susan Elizabeth Prust, PT DIP MDT
• Jerilyn Kay Prybell, O.D.
• Victoria G Pugh
• Kelly Jean Purcell, PA-C
• Pure Physical Therapy LLC

• Family Medicine Physician in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.