DR. ROBERT C PRENTICE (NPI# 1194789354) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194789354 |
| Entity Type | Individual |
| Full Name | DR. ROBERT C PRENTICE |
| Credential | D.O. |
| Practice Address |
13011 S 104th Ave Ste 100 Palos Park IL 60464-1508 |
| Practice Telephone | 7082743278 |
| Practice Fax Number | 7082743299 |
| Mailing Telephone | 7084783600 |
| Mailing Fax Number | 7084783552 |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2020-09-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
036067066 | IL | Allopathic & Osteopathic Physicians |
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
036067066 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS BLUE SHIELD | 01621208 | 01 |
| IL | MEDICARE GROUP | 236551 | 01 |
| IL | RAILROAD MEDICARE GROUP PTAN NUMBER | CN2703 | 01 |
| IL | 036067066 | 05 | |
| IL | RAILROAD MEDICARE GROUP PTAN NUMBER | CD8033 | 01 |
| IL | RAILROAD MEDICARE COOK | 060042297 | 01 |
| IL | MEDICARE GROUP | 236550 | 01 |
| IL | RAILROAD MEDICARE WILL | 060056572 | 01 |
| IL | GROUP NPI | 1508810086 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 19001 Old Lagrange Rd, Mokena, IL 604488012 | 7084784224 | 7084784033 |
| 10260 191st St Ste 102, Mokena, IL 604488802 | 7084784224 | 7084784033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093119489 | Robert Alexander Prentice | Psychologist | 2228 Murieta Way, Sacramento, CA 95822-2851 | 2014-10-14 |
| 1225418585 | Robert Prentice | Counselor | 365 Ne Court St, Prineville, OR 97754-1936 | 2015-06-02 |
| 1508880170 | Robert R Prentice | Pediatrics | 2301 House Ave, Suite 405, Cheyenne, WY 82001-3176 | 2006-07-27 |
| Street Address |
13011 S 104TH AVE STE 100 |
| City | PALOS PARK |
| State | IL |
| Zip Code | 60464-1508 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790749455 | John J Arrotti | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2006-04-12 |
| 1942844212 | Courtney Lee Montgomery | Nurse Practitioner | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2019-10-30 |
| 1396065884 | Hong Jun Yun | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464 | 2010-06-07 |
| 1831355585 | Gregory Paul Macaluso | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2008-08-01 |
| 1679778716 | Ravi Kumar Ramana | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2007-06-19 |
| 1043274145 | Robert A Iaffaldano | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2006-04-14 |
| 1932163037 | Thomas T Kason | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2006-04-14 |
| 1932163623 | Dominick J Stella | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2006-04-12 |
| 1225092992 | Roy C Bliley | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2006-04-12 |
| 1528022191 | Peter W Kakavas | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2006-04-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518456102 | Lisa Kay York | Behavior Technician | 8207 Il-83, Palos Park, IL 60464 | 2018-05-09 |
| 1972000479 | Elizabeth Faye Putman | Physical Therapy Assistant | 10300 Village Cir Dr, Peace Village, Palos Park, IL 60464 | 2018-04-11 |
| 1730446998 | Steven Jay Quinn | Internal Medicine | 11900 Southwest Hwy Ste 101, Palos Park, IL 60464 | 2012-04-12 |
| 1376677625 | Palos C C S D 118 | Local Education Agency (LEA) | 8800 West 119th Street, Palos Park, IL 60464 | 2007-03-16 |
| 1730233297 | Rajitha Lakshmi Avva | Psychiatry & Neurology | Palos Behavioral Health, 13011 S 104th Ave, Palos Park, IL 60464 | 2007-01-22 |
| 1487714671 | Maple Park Dental Care, P.C. | Dentist | 1048 104th Street, #108, Naperville, IL 60464 | 2006-12-11 |
| 1912065418 | David M Kozal | Dentist | 11900 Sw Hwy, Palos Park, IL 60464 | 2006-12-05 |
| 1598845422 | Michele Antoinette Nealon Woods | Psychologist | Palos Behavioral Health Professionals, 103011 S 104th Ave Suite 200, Palos Park, IL 60464 | 2006-10-16 |
| 1679683585 | Linda G Baer | Psychologist | 13011 104th Ave, Suite 200, Palos Park, IL 60464 | 2006-08-30 |
| 1578507430 | Hugh Michael Oneill | Family Medicine | 14741 Ravinia Ave, Orland Park, IL 60464 | 2006-06-15 |
| Find all providers in zip 60464 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104238534 | Heart Care Centers of Illinois, Sc | Internal Medicine | 13011 S 104th Ave, Palos Park, IL 60464-1506 | 2014-05-20 |
| 1831355585 | Gregory Paul Macaluso | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2008-08-01 |
| 1043274145 | Robert A Iaffaldano | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2006-04-14 |
| 1932163623 | Dominick J Stella | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2006-04-12 |
| 1225092992 | Roy C Bliley | Internal Medicine | 13011 S 104th Ave Ste 100, Palos Park, IL 60464-1508 | 2006-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528596350 | Stat Cardiologist Inc | Internal Medicine | 2425 W 22nd St Ste 209, Oak Brook, IL 60523-4655 | 2017-05-24 |
| 1306296074 | Safwan Gaznabi | Internal Medicine | Northshore University Healthsystem, Office of Academic Affairs 2650 Ridge Ave., Suite 1304, Evanston, IL 60201 | 2016-06-14 |
| 1154796290 | Ray Jean Pensinger | Internal Medicine | 105 S. Fleming Rd., Woodstock, IL 60098-7903 | 2015-12-01 |
| 1073905311 | Cardio Medical Center Sc | Internal Medicine | 7746 West Madison Ave, Forrest Park, IL 60131 | 2015-02-24 |
| 1427457399 | Charles Joseph Frahm | Internal Medicine | 1200 E Madison Park, Chicago, IL 60615-2961 | 2014-08-17 |
| 1225447725 | Jeremy R. Estrada | Internal Medicine | 5841 S Maryland Ave # Mc5841, Chicago, IL 60637-1447 | 2014-08-08 |
| 1285049197 | Nidhi Madan | Internal Medicine | 1717 W Congress Pkwy Ste 317, Chicago, IL 60612 | 2014-06-30 |
| 1295159184 | Ca Group, LLC | Internal Medicine | 4017 Illinois Route 159, Suite 101, Smithton, IL 62285 | 2014-02-12 |
| 1457788424 | Chicago Vascular Clinic Ltd | Internal Medicine | 812 E Woodfield Rd, Schaumburg, IL 60173-4714 | 2013-10-04 |
| 1942634688 | Vein Md Consultants, LLC | Internal Medicine | 1865 N. Eltnor Blvd., West Chicago, IL 60185-5900 | 2013-08-29 |
| Find all providers with the same taxonomy | ||||
| City | PALOS PARK |
| Zip Code | 60464 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.