NPIMap

Organization Active NPI

Presence Healthcare Services

  • Internal Medicine Physician
  • Park Ridge, IL
National Provider Identifier
1992812838
Registry record updated Apr 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRESENCE HEALTHCARE SERVICES
Doing business as
Presence Medical Group
Practice address
132 S Prospect Ave
Park Ridge, IL 60068-4064
Phone
(847) 825-6631
Fax
(847) 825-8684
NPI assigned
Aug 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2013

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

Authorized official

Name
Mrs. Melvonne Wickliffe-Jones
Title
Credentialing MGR
Phone
(630) 914-2417

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

132 S Prospect Ave
Park Ridge, IL 60068-4064

Mailing address

1000 Remington Boulevard
Bolingbrook, IL 60440-0000
Phone (630) 914-2417

Other identifiers 3

IdentifierTypeStateIssuer
036083859MedicaidIL
036054785MedicaidIL
036083268MedicaidIL

Other names 1

  • Presence Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050215000965 IL Part B Supplier - Clinic/Group Practice 2860396769 Receives reassigned benefits from 128 practitioners
47 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 46

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 46

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1400 Canfield Rd
Park Ridge, IL 60068

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365552000000",
    "number": "1992812838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 REMINGTON BOULEVARD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604400000",
            "telephone_number": "630-914-2417",
            "fax_number": "630-914-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 S PROSPECT AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684064",
            "telephone_number": "847-825-6631",
            "fax_number": "847-825-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2013-04-10",
        "status": "A",
        "authorized_official_last_name": "WICKLIFFE-JONES",
        "authorized_official_first_name": "MELVONNE",
        "authorized_official_title_or_position": "CREDENTIALING MGR",
        "authorized_official_telephone_number": "630-914-2417",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083859",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036054785",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083268",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Presence Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Park Ridge, IL

Sources for this page

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