DR. GLORIA JACKSON BACON (NPI# 1366500381) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366500381 |
| Entity Type | Individual |
| Full Name | DR. GLORIA JACKSON BACON |
| Credential | M.D., M.P.H. |
| Practice Address |
840 E 87th St A-2 Chicago IL 60619-6248 |
| Mailing Address |
2409 Upperline St New Orleans LA 70115-5957 |
| Practice Telephone | 7734879910 |
| Practice Fax Number | 7738731878 |
| Mailing Telephone | 7734055300 |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2012-09-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD.04768R | LA | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 036038566 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1010375 | 05 | |
| LA | MEDICARE PROVIDER NUMBER | 214545 | 01 |
| Street Address |
840 E 87TH ST A-2 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60619-6248 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831287861 | Vision Salon Eye Care Associates | Optometrist | 840 E 87th St, Suite 100, Chicago, IL 60619-6248 | 2006-10-11 |
| 1023494648 | Glenda K. Sanders | Counselor | 840 E 87th St, 100, Chicago, IL 60619-6248 | 2015-08-05 |
| 1154551976 | Covenant Healthcare Services & Staffing Inc. | Home Health | 840 E 87th St, Suite 211a, Chicago, IL 60619-6248 | 2009-07-15 |
| 1831241793 | Oliver Taylor Jr. | Dentist | 840 E 87th St, Suite 203, Chicago, IL 60619-6248 | 2007-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457985061 | Tonia Dorsey | Durable Medical Equipment & Medical Supplies | 951 E 80th Street, Apt 1, Chicago, IL 60619 | 2020-02-24 |
| 1821635509 | Lisa Strader | Technician | 8605 S. Dorchester, Chicago, IL 60619 | 2019-12-02 |
| 1821647579 | Deborah Joves | Technician | 8258 S. Woodlawn Ave, Chicago, IL 60619 | 2019-09-05 |
| 1194372458 | Cognitive Focus Centers, Inc. | Clinic/Center | 901 E 95th St, Chicago, IL 60619 | 2019-08-21 |
| 1588136360 | Zantraquilla Z Madkins | Transportation Broker | 7829 South Wabash, Chicago, IL 60619 | 2018-12-18 |
| 1619447497 | Bria Stanciel | Case Manager/Care Coordinator | 8419 S Cottage Grove, Chicago, IL 60619 | 2018-12-05 |
| 1184153520 | Jordane Kelley | Nurse's Aide | 7339 S Wabash Ave, Chicago, IL 60619 | 2017-06-08 |
| 1205362977 | Kristen Suing | Psychologist | 1111 E 87th St Ste 300, Chicago, IL 60619 | 2017-05-02 |
| 1720525280 | Senior Healthcare Services Inc | Physical Therapist | 9133 South Stoney Island, Chicago, IL 60619 | 2017-01-23 |
| 1932652567 | Md Orthotic & Prosthetic Laboratory, Inc. | Prosthetic/Orthotic Supplier | 1514 E 87th St Lowr Level, Chicago, IL 60619 | 2016-08-01 |
| Find all providers in zip 60619 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911495 | Moataz Barkat | Family Medicine | 3315 W 66th Pl, Chicago, IL 60629-3427 | 2020-10-26 |
| 1558976589 | Jasmine Ashley Fowler | Family Medicine | 2416 N Lotus Ave, Chicago, IL 60639-1435 | 2020-09-15 |
| 1720699176 | Healing Hands Resource Center Streator | Family Medicine | 2128 S Central Park Ave, Chicago, IL 60623-3113 | 2020-08-10 |
| 1285251892 | Soe Lwin Oo | Family Medicine | 1625 E 75th St # 1, Chicago, IL 60649-3603 | 2020-06-30 |
| 1124645700 | Timothy Alan Williams Jr. | Family Medicine | 1625 E 75th St Fl 1, Chicago, IL 60649-3603 | 2020-06-30 |
| 1194340026 | Kaysha Lynne Ribao | Family Medicine | 2116 S Springfield Ave, Chicago, IL 60623-2465 | 2020-06-16 |
| 1932724341 | Toni Kurian | Family Medicine | 1550 S Indiana Ave Apt 407, Chicago, IL 60605-4822 | 2020-06-11 |
| 1528689486 | Thurman J Robertson | Family Medicine | 1950 W. Polk Street, 7th Floor, Chicago, IL 60612-3714 | 2020-05-01 |
| 1629697297 | Lyndsey Danielle Johnson | Family Medicine | 2804 W Walton St, Chicago, IL 60622-4450 | 2020-04-13 |
| 1730708884 | Iruoma Genevieve Nwangwu | Family Medicine | 1950 W Polk Street, Chicago, IL 60612-3714 | 2020-04-09 |
| 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.