NPIMap

Organization Active NPI

Resilience Healthcare- Lakefront Medical Associates, LLC

Doing business as Chicago Health Medical Group

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1912470105
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RESILIENCE HEALTHCARE- LAKEFRONT MEDICAL ASSOCIATES, LLC
Doing business as
Chicago Health Medical Group
Practice address
6201 North Broadway
Chicago, IL 60660
Phone
(844) 533-2464
NPI assigned
Jan 10, 2019
Last updated
Jan 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

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

Authorized official

Name
Manoj Prasad
Title
Ceo
Phone
(708) 763-6700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

6201 North Broadway
Chicago, IL 60660

Mailing address

4646 N Marine Dr
Chicago, IL 60640-5759

Other names 2

  • Chicago Health Medical Group Doing business as
  • CHMG - Edgewater Other name

National Provider Directory

National Provider Directory
Tax ID family
Chicago Health Medical Group14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

6201 N Broadway St
Chicago, IL 60660
Phone (773) 564-5102

NPI Registry JSON

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

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1912470105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 N MARINE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6201 NORTH BROADWAY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60660",
            "telephone_number": "844-533-2464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESILIENCE HEALTHCARE- LAKEFRONT MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-10",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "PRASAD",
        "authorized_official_first_name": "MANOJ",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-763-6700"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chicago Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHMG - Edgewater",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CHMG - Edgewater",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jan 13, 2023; 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.