Proactive MD Il SC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PROACTIVE MD IL SC

Practice address

4 Parkway North Blvd
Deerfield, IL 60015-2502

Phone

(847) 943-9950

NPI assigned

Jan 18, 2022

Organization subpart

No

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

Authorized official

Name

Mark Kemble, MD

Title

Cmo

Phone

(864) 501-0751

Specialties & licenses 1

Addresses

Other names 1

• PROACTIVE MD CFI Deerfield Health Center Doing business as

Tax ID family

Oe 520 Health Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Proactive MD Il SC

  • Primary Care Clinic/Center
  • O Fallon, IL
  • NPI 1881488773
  NPD tax ID
• Proactive MD Il SC

  • Primary Care Clinic/Center
  • Greenville, SC
  • NPI 1700538121
  NPD tax ID

Locations

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

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744243200000",
    "number": "1922759349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 ALLAWOOD CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296816207",
            "telephone_number": "864-501-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 PARKWAY NORTH BLVD",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600152502",
            "telephone_number": "847-943-9950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MD IL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-18",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A",
        "authorized_official_last_name": "KEMBLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "864-501-0751",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROACTIVE MD CFI Deerfield Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROACTIVE MD CFI Deerfield Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Linda Porter, LCPC
• Sheila Poteshman, OTR
• Diana Powitz, LCSW
• Premise Health of Illinois Medical, PC
• Roxanne Prigge
• Jennifer E Prosk, OT
• Psychological Counseling Center, LLC
• Quality Physical Therapy and Rehabilitation PC
• Quality Physical Therapy PC
• Meredith Lea Quarello, PSYD

• Primary Care Clinic/Center in Deerfield, IL
• Providers in Deerfield, 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 Apr 10, 2025; 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.