MIDWEST PHYSICIAN GROUP LTD (NPI# 1639216435) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639216435 |
| Entity Type | Organization |
| Organization Name | MIDWEST PHYSICIAN GROUP LTD |
| Other Organization Name | MIDWEST PHYSICIAN CENTER OF BEVERLY |
| Practice Address |
10242 S Vincennes Ave Chicago IL 60643-1301 |
| Mailing Address |
20110 Governors Hwy Olympia Fields IL 60461-1030 |
| Practice Telephone | 7732381676 |
| Practice Fax Number | 7732381641 |
| Mailing Telephone | 7087477960 |
| Mailing Fax Number | 7085033993 |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DEBORAH J NELSON (CEO) |
| Authorized Official Telephone | 7087477960 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 0001616617 | 01 |
| Other Name | Type Code |
|---|---|
| MIDWEST PHYSICIAN CENTER OF BEVERLY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942494174 | Midwest Physician Group Ltd | Clinic/Center | 1051 Essington Road, Silver Cross Medical Center, Joliet, IL 60931 | 2007-08-30 |
| 1215074026 | Midwest Physician Group Ltd | Family Medicine | 13811 Cicero Ave, Crestwood, IL 60445-1826 | 2007-01-31 |
| 1053599167 | Midwest Physician Group Ltd | Clinic/Center | 20110 Governors Hwy, 1st Floor, Olympia Fields, IL 60461-1030 | 2008-01-31 |
| 1790976231 | Midwest Physician Group Ltd | Nurse Practitioner | 3800 W 203rd St, Olympia Fields, IL 60461-1184 | 2007-08-08 |
| 1104944214 | Midwest Physician Group Ltd | Clinic/Center | 4001 Vollmer Road, Olympia Fields, IL 60461 | 2007-03-27 |
| 1073650818 | Midwest Physician Group Ltd | Family Medicine | 595 William R Latham Sr Dr, Bourbonnais, IL 60914-2319 | 2007-01-31 |
| 1972640654 | Midwest Physician Group Ltd | Internal Medicine | 3800 W 203rd St, Suite 202, Olympia Fields, IL 60461-1184 | 2007-01-31 |
| 1285771972 | Midwest Physician Group Ltd | Family Medicine | 4001 Vollmer Rd, Olympia Fields, IL 60461 | 2007-01-31 |
| 1073650560 | Midwest Physician Group Ltd | Family Medicine | 11250 S Western Ave, Chicago, IL 60643-4116 | 2007-01-31 |
| 1699812487 | Midwest Physician Group Ltd | Family Medicine | 3201 S Wallace St, Chicago, IL 60616-3501 | 2007-01-31 |
| Street Address |
10242 S VINCENNES AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60643-1301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942311972 | Jennette Latrese Berry | Family Medicine | 10242 S Vincennes Ave, Chicago, IL 60643-1301 | 2006-08-31 |
| 1528162062 | Richard Allen Margolin | Family Medicine | 10242 S Vincennes Ave, Chicago, IL 60643-1301 | 2006-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154941698 | Breann Hampton | Behavior Technician | 1214 W 115th St, Chicago, IL 60643 | 2020-04-24 |
| 1366075566 | Sanctuary Counseling, LLC | Home Health | 12247 S Racine Ave, Calumet Park, IL 60643 | 2020-02-16 |
| 1467082883 | Juliana Frances Cunningham | Developmental Therapist | 10037 S Bell, Chicago, IL 60643 | 2020-01-24 |
| 1013578624 | Sct Counseling | Counselor | 11948 S Western Ave, Chicago, IL 60643 | 2019-06-25 |
| 1073087474 | For Eyes Optical Company of Pa | Optometrist | 9900 S Ridgleland Ave, Chicago Ridge, IL 60643 | 2019-01-18 |
| 1073096426 | Derek Peake | Physical Therapist | 9465 S. Western Road, Chicago, IL 60643 | 2018-09-12 |
| 1508356072 | Halo Medical Professionals Sc. | Chiropractor | 10650 S Western Ave, Chicago, IL 60643 | 2018-05-10 |
| 1811405699 | Kara Eileen Noland | Developmental Therapist | 9327 S Hamilton Ave, Chicago, IL 60643 | 2018-01-16 |
| 1588173546 | Kiah Nicole Bouie | Behavioral Analyst | 1461 W 113th Pl, Chicago, IL 60643 | 2017-09-21 |
| 1174042766 | Travis Wade Robertson | Physical Therapist | 10909-11 S Western Ave, Beverly, IL 60643 | 2017-09-14 |
| Find all providers in zip 60643 | ||||
| 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 | ||||
Please comment or provide details below to improve the information on MIDWEST PHYSICIAN GROUP LTD.
| 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.