Community First Healthcare of Illinois, Inc.
Organization Active NPI Internal Medicine Physician · Chicago, IL
NPI 1962894675 · NPPES record last updated Jun 6, 2025
Key facts
- NPI
- 1962894675
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- COMMUNITY FIRST HEALTHCARE OF ILLINOIS, INC.
- Practice address
- 5645 W Addison St
Chicago, IL 60634-4403 - Phone
- (773) 794-8320
- Fax
- (773) 527-5900
- NPI assigned
- Mar 4, 2015
- Organization subpart
- No
Authorized official
- Name
- Edward J Green
- Title
- Principal
- Phone
- (773) 794-8320
Other NPIs on the same Medicare enrollment 2
Practitioners 79
-
Anthony Anibal Acosta, M.D.
-
Muhammad Ali, M.D
-
Lara Alkhawaldeh, M.D
-
Kathleen Maria Barak, APN
-
Jarrod S Barker, M.D.
-
Ahmad Bastani, MD
-
Kevin Boubouleix, MD
-
Sharona Bryant, M.D.
-
Marc A Dorfman, MD
-
Ila Englof, M.D.
-
Sagun Gautam, MD
-
Asha George, APN
-
Sean T Grant, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160104001552 | IL | Part B Supplier - Clinic/Group Practice | 2860716685 |
Receives reassigned benefits from 186 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chicago, IL |
National Provider Directory
Locations
5645 W Addison St
Ste 302
Chicago, IL 60634
5600 W Addison St
Chicago, IL 60634
Phone (773) 202-8444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Diagnostic Radiology Physician |
2085R0202X |
Addresses
Primary practice location
5645 W Addison St
Chicago, IL 60634-4403
Mailing address
5645 W Addison St
Chicago, IL 60634-4403
Phone (773) 794-8320
Other names
- Community First Medical Group
NPI Registry JSON
{
"created_epoch": "1425427200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1749168000000",
"number": "1962894675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5645 W ADDISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606344403",
"telephone_number": "773-794-8320",
"fax_number": "773-527-5900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5645 W ADDISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606344403",
"telephone_number": "773-794-8320",
"fax_number": "773-527-5900"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMMUNITY FIRST HEALTHCARE OF ILLINOIS, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2015-03-04",
"last_updated": "2025-06-06",
"certification_date": "2025-06-06",
"status": "A",
"authorized_official_last_name": "GREEN",
"authorized_official_first_name": "EDWARD",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "PRINCIPAL",
"authorized_official_telephone_number": "773-794-8320"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Community First Medical Group",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Chicago, IL
- Community First Healthcare of Illinois, Inc.
- Community First Healthcare of Illinois, Inc.
- Community First Healthcare of Illinois, Inc.
- Community First Healthcare of Illinois, Inc.
- Community First Healthcare of Illinois, Inc.
- Community Health Alliance PLLC
- Community Health and Immunization Services, LLC
- Community Health Intergrated Coporation
- Community Health Partnership of Illinois
- Community Help Center
All providers in Chicago, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.