DR. JACK D CLEMIS (NPI# 1740272483) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740272483 |
| Entity Type | Individual |
| Full Name | DR. JACK D CLEMIS |
| Credential | M.D. |
| Practice Address |
151 N Michigan Ave #914 Chicago IL 60601-7506 |
| Practice Telephone | 3129384327 |
| Practice Fax Number | 3129380490 |
| Mailing Telephone | 3129384327 |
| Mailing Fax Number | 3129380490 |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2013-02-13 |
| NPI Deactivation Date | 03/21/2006 |
| NPI Reactivation Date | 2006-04-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0901X |
Otolaryngology Specialization: Otology & Neurotology |
036-038421 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS | 1604366 | 01 |
| Street Address |
151 N MICHIGAN AVE #914 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60601-7506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154329274 | Howard Lawrence Herman | Psychiatry & Neurology | 151 N Michigan Ave, #811, Chicago, IL 60601-7506 | 2005-07-12 |
| 1306264163 | Piotr Barysenka | Dentist | 151 N Michigan Ave, Apt 2217, Chicago, IL 60601-7506 | 2014-03-30 |
| 1811329022 | Laura Thometz Puglessi | Physician Assistant | 151 N Michigan Ave, Apt 2603, Chicago, IL 60601-7506 | 2013-07-30 |
| 1992046080 | Steven Goostree | Physical Therapist | 151 N Michigan Ave, Milennium Station Suite C-47, Chicago, IL 60601-7506 | 2013-03-14 |
| 1053663591 | Aspire Consulting, Inc. | Behavioral Analyst | 151 N Michigan Ave, #1909, Chicago, IL 60601-7506 | 2012-10-08 |
| 1821357898 | Morgan Gabrielle Mix | Behavioral Analyst | 151 N Michigan Ave, 1909, Chicago, IL 60601-7506 | 2012-05-11 |
| 1588961775 | Mclorn Whitt | Audiologist-Hearing Aid Fitter | 151 N Michigan Ave, #913, Chicago, IL 60601-7506 | 2011-02-24 |
| 1568765998 | Theresa Nollette Lcsw Ltd | Social Worker | 151 N Michigan Ave, Suite 911, Chicago, IL 60601-7506 | 2010-12-07 |
| 1285849554 | Cheryl Neuman Meltzer | Social Worker | 151 N Michigan Ave, Suite 911, Chicago, IL 60601-7506 | 2007-05-11 |
| 1023131299 | Karen W. Bloomberg, Ph.d., Ltd. | Social Worker | 151 N Michigan Ave, Suite 802, Chicago, IL 60601-7506 | 2007-04-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811527013 | Chicago Center for Advanced Dentistry | Dentist | 222 N Lasalle St 230, Chicago, IL 60601 | 2020-01-16 |
| 1689131146 | Nicole Lauren Rothman | Social Worker | 155 N Michigan Ave Ste 500a, Chicago, IL 60601 | 2019-02-20 |
| 1861976532 | Mhn Aco, LLC | Case Management | 180 N. Stetson Avenue, Suite 600-1, 180 N. Stetson Avenue, Suite 600-1, Chicago, IL 60601 | 2018-09-19 |
| 1659861409 | Alison Hirshorn LLC | Community/Behavioral Health | 155 N Michigan Ave Ste 603, Chicago, IL 60601 | 2018-05-17 |
| 1427574714 | Nicole Woodcox Bolden | Social Worker | 205 N Michigan Ave Ste 1660, Chicago, IL 60601 | 2017-08-17 |
| 1912431560 | Shannon Keleher | Social Worker | 155 N Michigan Ave Ste 209, Chicago, IL 60601 | 2017-04-19 |
| 1659828630 | Kevin Mcguyer | Physical Therapist | 151 N Michgan Ave, Chicago, IL 60601 | 2016-09-07 |
| 1598116618 | Charles Raymond Culpepper | Counselor | 155 N Michigan Ave Ste 608, Chicago, IL 60601 | 2016-06-30 |
| 1629494042 | Farah Huq | Counselor | 180 N Michigan Ave, Ste 410, Chicago, IL 60601 | 2014-03-10 |
| 1609147628 | Kathleen M Walsh | Social Worker | 155 N Michigan Av, #523, Chicago, IL 60601 | 2012-01-23 |
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| Taxonomy Code | 207YX0901X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otology & Neurotology |
| An otolaryngologist who treats diseases of the ear and temporal bone, including disorders of hearing and balance. The additional training in otology and neurotology emphasizes the study of embryology, anatomy, physiology, epidemiology, pathophysiology, pathology, genetics, immunology, microbiology and the etiology of diseases of the ear and temporal bone. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760657381 | Heather Maureen Weinreich | Otolaryngology | 1855 W Taylor St Dept Of, Chicago, IL 60612-7242 | 2008-04-24 |
| 1609134063 | Terence Edward Imbery | Otolaryngology | 5841 S Maryland Ave # Mc1035, Chicago, IL 60637 | 2012-04-24 |
| 1992905426 | Timothy C Hain, Md, PC | Otolaryngology | 645 N Michigan Ave, Suite 410, Chicago, IL 60611-2826 | 2007-07-23 |
| 1346315017 | Richard Mark Wiet | Otolaryngology | 1611 W Harrison St, Suite 550, Chicago, IL 60612-4861 | 2006-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669448056 | Griffith Hsu | Otolaryngology | 430 Pennsylvania Ave # 330, Glen Ellyn, IL 60137-4464 | 2006-02-24 |
| 1790029593 | Adventist Health Partners, Inc | Otolaryngology | 11 Salt Creek Ln, Suite 101, Hinsdale, IL 60521-2990 | 2012-11-16 |
| 1598982571 | Ear Institute of Chicago LLC | Otolaryngology | 11 Salt Creek Ln, Suite 101, Hinsdale, IL 60521-2902 | 2007-04-19 |
| 1053491639 | Dennis M Moore Md Sc | Otolaryngology | 1875 Dempster, Suite 625, Park Ridge, IL 60068 | 2006-10-17 |
| 1295832483 | Dennis Michael Moore | Otolaryngology | 1875 Dempster, Suite 625, Park Ridge, IL 60068 | 2006-09-20 |
| 1033129762 | Arvind Kumar | Otolaryngology | 950 N York Rd, Suite 102, Hinsdale, IL 60521-2950 | 2006-08-08 |
| 1699752568 | Sam Marzo | Otolaryngology | 2160 S 1st Ave, Maguire Center 1870, Maywood, IL 60153-3328 | 2005-12-30 |
| 1962489823 | John Leonetti | Otolaryngology | 2160 S First Ave, Maguire Center 1870, Maywood, IL 60153 | 2005-12-30 |
| 1760464911 | Richard J Wiet | Otolaryngology | 11 Salt Creek Ln, Suite 101, Hinsdale, IL 60521-2990 | 2005-11-15 |
| 1770565947 | Robert Andrew Battista | Otolaryngology | 11 Salt Creek Ln, Suite 101, Hinsdale, IL 60521-2990 | 2005-11-15 |
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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.