Northwest Chicago Primary Care SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036124775 Issued in IL

Legal business name

NORTHWEST CHICAGO PRIMARY CARE SC

Practice address

5641 W Irving Park Rd
Chicago, IL 60634-2742

Phone

(773) 635-5700

Fax

(773) 635-5050

NPI assigned

Apr 26, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Charlemagne G Guerrero, M.D.NPI 1871715540

Title

President

Phone

(773) 504-0727

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DFFBCA

Practitioners 1

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

• Charlemagne G Guerrero, M.D.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1871715540
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1335398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378771200000",
    "number": "1962760017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 N 76TH CT",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "607071101",
            "telephone_number": "773-635-5700",
            "fax_number": "773-635-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5641 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606342742",
            "telephone_number": "773-635-5700",
            "fax_number": "773-635-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST CHICAGO PRIMARY CARE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-26",
        "last_updated": "2013-09-10",
        "status": "A",
        "authorized_official_last_name": "GUERRERO",
        "authorized_official_first_name": "CHARLEMAGNE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-504-0727",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036124775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "DT5494",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northwest Adult Wellness Center LLC
• Northwest Advanced Surgical Associates, SC
• Northwest Ambucare
• Northwest Anesthesiologists, S.C.
• Northwest Chicago Medical LTD
• Northwest Chiropractix Inc.
• Northwest Dentistry
• Northwest ENT Associates, S.C.
• Northwest General Surgeons LTD
• Northwest Health Care, LTD

• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.