Crestwood Associated Medical Center Ltd is a medicare enrolled "Family Medicine" provider in Crestwood, Illinois. Their current practice location is
13705 Cicero Ave, Crestwood, Illinois. You can reach out to their office (for appointments etc.) via phone at
(708) 385-4416.
Crestwood Associated Medical Center Ltd is licensed to practice in Illinois (license number 036.103914) and it also participates in the medicare program. Crestwood Associated Medical Center Ltd
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1104341163.
Healthcare Provider's Profile
| Full Name | Crestwood Associated Medical Center Ltd |
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| Type | Facility |
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| Speciality | Family Medicine |
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| Location | 13705 Cicero Ave, Crestwood, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1104341163
- Provider Enumeration Date: 08/10/2017
- Last Update Date: 07/21/2022
Medicare PECOS Information:
- PECOS PAC ID: 2466871959
- Enrollment ID: O20201002000283
Medical Identifiers
Medical identifiers for Crestwood Associated Medical Center Ltd such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1104341163 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111N00000X | Chiropractor | 038010310 (Illinois) | Secondary |
| 207Q00000X | Family Medicine | 036.103914 (Illinois) | Primary |
| 207X00000X | Orthopaedic Surgery | 036039801 (Illinois) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | 070.005243 (Illinois) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Crestwood Associated Medical Center Ltd acts as a billing entity for following providers:
| Provider Name | John W Revello |
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| Provider Type | Practitioner - Chiropractic |
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| Provider Identifiers | NPI Number: 1710928056
PECOS PAC ID: 6406894286
Enrollment ID: I20050421001010 |
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| Provider Name | Krishna D Parameswar |
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| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
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| Provider Identifiers | NPI Number: 1780620690
PECOS PAC ID: 2769414101
Enrollment ID: I20050907000060 |
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| Provider Name | Vincent Tupper |
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| Provider Type | Practitioner - Interventional Pain Management |
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| Provider Identifiers | NPI Number: 1609139583
PECOS PAC ID: 1557643368
Enrollment ID: I20170509000221 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Crestwood Associated Medical Center Ltd is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Crestwood Associated Medical Center Ltd
13705 S. Cicero Ave.,
Crestwood, IL 60445
Ph: (708) 385-4416 | Crestwood Associated Medical Center Ltd
13705 Cicero Ave,
Crestwood, IL 60418-1824
Ph: (708) 385-4416 |
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