JACK C. ENTER JR. (NPI# 1366444184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366444184 |
| Entity Type | Individual |
| Full Name | JACK C. ENTER JR. |
| Credential | PA-C |
| Practice Address |
4211 N Cicero Ave Suite 100 Chicago IL 60641-1651 |
| Mailing Address |
10100 Forest Hills Rd Machesney Park IL 61115-8234 |
| Practice Telephone | 7737941000 |
| Practice Fax Number | 7737949986 |
| Mailing Telephone | 8157132742 |
| Mailing Fax Number | 8152828597 |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2008-10-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085-000925 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | LICENSE | 085.000925 | 01 |
| Street Address |
4211 N CICERO AVE SUITE 100 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60641-1651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205378460 | Caroline Rodriguez | Nurse Practitioner | 4211 N Cicero Ave, Chicago, IL 60641-1651 | 2016-11-04 |
| 1114342037 | Lauren Kimberly Hofius | Specialist/Technologist, Other | 4211 N Cicero Ave, #400, Chicago, IL 60641-1651 | 2014-02-28 |
| 1477892917 | Jacob M Richey | Podiatrist | 4211 N Cicero Ave, Chicago, IL 60641-1651 | 2013-02-04 |
| 1558611624 | Sophia Zamudio Rasof | Family Medicine | 4211 N Cicero Ave, Suite 308, Chicago, IL 60641-1651 | 2012-09-14 |
| 1265792212 | Sonia Shah M D S C | Internal Medicine | 4211 N Cicero Ave, Suite 203, Chicago, IL 60641-1651 | 2012-05-24 |
| 1740585736 | Chandra B Rathod Mdsc | Clinic/Center | 4211 N Cicero Ave, Suite 203, Chicago, IL 60641-1651 | 2011-01-21 |
| 1538460134 | Six Corners Anesthesia LLC | Anesthesiology | 4211 N Cicero Ave, Suite 400, Chicago, IL 60641-1651 | 2010-11-12 |
| 1720225469 | Diana Barros | Physician Assistant | 4211 N Cicero Ave, Suite #200, Chicago, IL 60641-1651 | 2009-01-16 |
| 1801055777 | Gerard P Alleje | Physical Therapist | 4211 N Cicero Ave, Suite #200, Chicago, IL 60641-1651 | 2008-06-05 |
| 1285806596 | James D Wnek Jr. | Physical Therapy Assistant | 4211 N Cicero Ave, Suite 100, Chicago, IL 60641-1651 | 2008-03-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063038131 | Victoria Carmen Grau Kazmierzcak | Student in an Organized Health Care Education/Training Program | 5458 W Grace St, Unit 2, Chicago, IL 60641 | 2020-06-24 |
| 1659926921 | Farah Alhaidar | Counselor | 4028 W Irving Park Rd Loft B, Chicago, IL 60641 | 2019-08-05 |
| 1255898482 | Bernadeta Agnieszka Kapustka | Nurse Practitioner | 5425 W Addison, Chicago, IL 60641 | 2019-02-24 |
| 1295200921 | The Dental Masters of Belmont, LLC | Dentist | 5236 W. Belmont Ave., Chicago, IL 60641 | 2018-10-09 |
| 1700364171 | National Vision Inc | Technician/Technologist | 4068 North Milwaukee Avenue, Chicago, IL 60641 | 2018-07-30 |
| 1477055168 | Elaine Vozar Acupuncturist Ltd | Acupuncturist | 3817 N. Pulaski, Chicago, IL 60641 | 2018-03-08 |
| 1174906853 | Heather Rocco | Hearing Instrument Specialist | 4122 N Millwaukee Ave, Chicago, IL 60641 | 2015-06-30 |
| 1770910184 | Kendra Manning | Physician Assistant | 4959 W. Belmont Ave, Chicago, IL 60641 | 2013-09-30 |
| 1679916274 | Don E Mccree | Technician, Cardiology | 2936 N. Kolmar, 3c, Chicago, IL 60641 | 2013-04-12 |
| 1053664888 | Scott P Dusenbery | Occupational Therapist | 3235 N Lockwood Apt 3, Chicago, IL 60641 | 2012-10-17 |
| Find all providers in zip 60641 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508470709 | Bryan Ying Wong | Physician Assistant | 3420 S Morgan St Apt 2e, Chicago, IL 60608-6904 | 2020-09-04 |
| 1245858117 | Emily Victoria Headley | Physician Assistant | 1431 N Western Ave Ste 134, Chicago, IL 60622-1797 | 2020-07-08 |
| 1548884547 | Crystal Afua Amoah | Physician Assistant | 1665 N Orchard St Apt 104, Chicago, IL 60614-5385 | 2020-06-04 |
| 1841814274 | Zubair Aslam Khan | Physician Assistant | 3037 W Wilson Ave Apt 2w, Chicago, IL 60625-4345 | 2020-06-01 |
| 1659991818 | Taylor Nicole Anderson | Physician Assistant | 25 W Randolph St Apt 603, Chicago, IL 60601-3514 | 2020-04-17 |
| 1720616444 | Melanie Doretti | Physician Assistant | 3052 N Seminary Ave Apt 2r, Chicago, IL 60657-6788 | 2020-03-29 |
| 1154958544 | Joerissa Gearlds | Physician Assistant | 5645 W Addison St Rm 353, Chicago, IL 60634-4403 | 2020-03-25 |
| 1932736816 | Taylor Evan Fisher | Physician Assistant | 3033 N Sheridan Rd Apt 301, Chicago, IL 60657-5578 | 2020-03-23 |
| 1285260844 | Krista A Saum | Physician Assistant | 661 W Sheridan Rd Apt 601, Chicago, IL 60613-3311 | 2020-03-16 |
| 1386278430 | Adara Simonelli | Physician Assistant | 6317 S Lorel Avenue, Chicago, IL 60638 | 2020-02-27 |
| 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.