MACENTEE KNOX & VARGAS MDS (NPI# 1275729303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275729303 |
| Entity Type | Organization |
| Organization Name | MACENTEE KNOX & VARGAS MDS |
| Other Organization Name | SOUTHCARE FAMILY PRACTICE |
| Practice Address |
10627 S Pulaski Rd Chicago IL 60655-3827 |
| Practice Telephone | 7737799300 |
| Practice Fax Number | 7737795768 |
| Mailing Telephone | 7737799300 |
| Mailing Fax Number | 7737795768 |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2011-03-08 |
| Authorized Official Name | DR. PETER F MACENTEE (PRESIDENT) |
| Authorized Official Telephone | 7737799300 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 305R00000X | Preferred Provider Organization | 036047977 | IL | Managed Care Organizations |
| N | 305S00000X | Point of Service | 036063080 | IL | Managed Care Organizations |
| Y | 305R00000X | Preferred Provider Organization | 036072512 | IL | Managed Care Organizations |
| Other Name | Type Code |
|---|---|
| SOUTHCARE FAMILY PRACTICE | Doing Business As Name - Organization |
| Street Address |
10627 S PULASKI RD |
| City | CHICAGO |
| State | IL |
| Zip Code | 60655-3827 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700974821 | Timothy E Knox | Family Medicine | 10627 S Pulaski Rd, Chicago, IL 60655-3827 | 2006-10-11 |
| 1467540567 | Rafael J Vargas-zapata | Family Medicine | 10627 S Pulaski Rd, Chicago, IL 60655-3827 | 2006-10-11 |
| 1417045501 | Peter F Macentee | Family Medicine | 10627 S Pulaski Rd, Chicago, IL 60655-3827 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629632401 | Hillary Woodward Carroll | Nurse Practitioner | 3258 W 111th Chicago, Il, Chicago, IL 60655 | 2019-04-26 |
| 1679029995 | Meghan Robbins | Pharmacy Technician | 10428 S. Springfield, Chicago, IL 60655 | 2016-08-28 |
| 1356700728 | Molly Samansky | Speech-Language Pathologist | 2549 W 106thh Pl, Chicago, IL 60655 | 2016-02-15 |
| 1134533615 | Axis Physical Medicine | Physical Therapist | 11005 S Kedzie Ave, Chicago, IL 60655 | 2014-06-12 |
| 1821439738 | Mercy Circle | Skilled Nursing Facility | 3659 W. 99th Street, Chicago, IL 60655 | 2013-07-09 |
| 1962772921 | E.m. Branch and Associates, Inc | Social Worker | 3139 W. 111th Street, Chicago, IL 60655 | 2012-01-09 |
| 1922377951 | Patricia Murphy | Counselor | 10435 Kedzie Ave, Chicago, IL 60655 | 2011-12-20 |
| 1346518891 | Kelly Diana Koch | Occupational Therapist | 11143 S. Troy, Chicago, IL 60655 | 2011-12-12 |
| 1265678544 | Lawrence Michael Furlan | Dentist | 10900 S Kedzie, Chicago, IL 60655 | 2008-12-17 |
| 1710122361 | Athletico, Ltd | Physical Therapist | 3644 W. 111th Street, Chicago, IL 60655 | 2008-12-11 |
| Find all providers in zip 60655 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972129625 | Shawnte Jenkins-alexander, Ed.d. Lcpc. Ltd | Preferred Provider Organization | 155 N Michigan Ave Ste 328, Chicago, IL 60601-7591 | 2020-06-18 |
| 1053876367 | Hope Network Foundation | Preferred Provider Organization | 332 S Michigan Ave Ste 10850, Chicago, IL 60604-4434 | 2019-01-31 |
| 1801336441 | Emily Edelman Psychotherapy, An Illinois Corporation | Preferred Provider Organization | 2100 S Marshall Blvd, Apt 804, Chicago, IL 60623-3679 | 2017-03-01 |
| 1417310335 | The Metro Mentorship Initiative | Preferred Provider Organization | 1828 N Lowell Ave, Chicago, IL 60639-4818 | 2016-03-29 |
| 1982081055 | Abc Dental PC | Preferred Provider Organization | 4608 W Diversey Ave, Chicago, IL 60639-1801 | 2015-04-28 |
| 1093119521 | 3 H Care Inc. | Preferred Provider Organization | 4850 S Lake Park Ave Apt 1710, Chicago, IL 60615-2073 | 2014-10-13 |
| 1578988937 | Joshua Allied Home Health Corporation | Preferred Provider Organization | 4250 N Marine Dr Apt 2534, Chicago, IL 60613-1741 | 2014-02-21 |
| 1891119590 | Rimya | Preferred Provider Organization | 2545 W Diversey Ave, Chicago, IL 60647-7172 | 2014-02-15 |
| 1639442536 | Park Smile Design | Preferred Provider Organization | 300 W Adams St Ste 323, Chicago, IL 60606-5107 | 2012-02-23 |
| 1669799813 | Body Works Health & Wellness LLC | Preferred Provider Organization | 825 W. Monroe St., Chicago, IL 60607 | 2010-04-28 |
| Find all providers in CHICAGO | ||||
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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.