| Portage Cragin Outpatient | |
|
4840 W Byron St Chicago IL 60641-2712 | |
| (773) 282-7800 | |
| (773) 282-2163 |
| Full Name | Portage Cragin Outpatient |
|---|---|
| Speciality | Clinic/Center |
| Location | 4840 W Byron St, Chicago, Illinois |
| Authorized Official Name and Position | Mark Stutrud (PRESIDENT) |
| Authorized Official Contact | 8476354600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portage Cragin Outpatient 1001 E Touhy Ave Ste 50 Des Plaines IL 60018-5817 Ph: (847) 635-4600 | Portage Cragin Outpatient 4840 W Byron St Chicago IL 60641-2712 Ph: (773) 282-7800 |
| NPI Number | 1063637684 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 12/31/2019 |
| Certification Date | 12/31/2019 |
| Medicare PECOS PAC ID | 2163403551 |
|---|---|
| Medicare Enrollment ID | O20050322001114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063637684 | NPI | - | NPPES |
| 0001618748 | Other | IL | BLUE CROSS BLUE SHIELD |
| Provider Name | Linda Malstrom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154427128 PECOS PAC ID: 7416954870 Enrollment ID: I20061026000451 |
| Provider Name | Lisa E Siegel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104926906 PECOS PAC ID: 2466450762 Enrollment ID: I20061121000350 |
| Provider Name | Patricia R Pipp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679738348 PECOS PAC ID: 7517025604 Enrollment ID: I20081017000508 |
| Provider Name | Paula R Christiansen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235334426 PECOS PAC ID: 0244399350 Enrollment ID: I20081104000696 |
| Provider Name | Colleen A Mikula |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518081686 PECOS PAC ID: 1456400761 Enrollment ID: I20090515000382 |
| Provider Name | Margaret Andrews |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023150935 PECOS PAC ID: 0749469278 Enrollment ID: I20110128000886 |
| Provider Name | Deep Buch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518113786 PECOS PAC ID: 7012162951 Enrollment ID: I20130227000114 |
| Provider Name | Susan E Niezgoda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952491110 PECOS PAC ID: 9032197298 Enrollment ID: I20140416000917 |
| Provider Name | Marian R Glenn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265858013 PECOS PAC ID: 9830314715 Enrollment ID: I20140709001052 |
| Provider Name | Rachel Dahlgren |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598143158 PECOS PAC ID: 4688995384 Enrollment ID: I20150605002810 |
| Provider Name | Jaime Esquivel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285812925 PECOS PAC ID: 0840501631 Enrollment ID: I20150619001799 |
| Provider Name | Katie G Rahoi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124412168 PECOS PAC ID: 0941513642 Enrollment ID: I20150724010096 |
| Provider Name | Peter W Nichols |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013112143 PECOS PAC ID: 1759690811 Enrollment ID: I20151013000290 |
| Provider Name | Dorothy A Valin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053500355 PECOS PAC ID: 7719282144 Enrollment ID: I20160223002694 |
| Provider Name | Paul E Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073060620 PECOS PAC ID: 0547548554 Enrollment ID: I20161026001415 |
| Provider Name | Valerie Y Riley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134580335 PECOS PAC ID: 3476813791 Enrollment ID: I20180207000270 |
| Provider Name | Aloha P Leblanc |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437665411 PECOS PAC ID: 1456613504 Enrollment ID: I20180329001508 |
| Provider Name | Cristina I Camaras Lieberson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548797558 PECOS PAC ID: 9032465844 Enrollment ID: I20180710001393 |
| Provider Name | Donna Catherine Czech |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396104501 PECOS PAC ID: 3971800566 Enrollment ID: I20180823002267 |
| Provider Name | Leroy M Lambey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548754039 PECOS PAC ID: 9830448885 Enrollment ID: I20180823002743 |
| Provider Name | Patricia Grayson-canty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841768660 PECOS PAC ID: 9830434497 Enrollment ID: I20181231000732 |
| Provider Name | Taryrsha Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821552761 PECOS PAC ID: 7911246368 Enrollment ID: I20190228002263 |
| Provider Name | Samantha R Dotson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932758968 PECOS PAC ID: 9032449871 Enrollment ID: I20190923000308 |
| Provider Name | Tomas A Torres |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881224921 PECOS PAC ID: 6800217134 Enrollment ID: I20200522000350 |
| Provider Name | Laura M Haberer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689207508 PECOS PAC ID: 2668897497 Enrollment ID: I20200810003535 |
| Provider Name | Lauren R Feld |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336542109 PECOS PAC ID: 8527478478 Enrollment ID: I20201103002694 |
| Provider Name | Arshad R Papa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730685561 PECOS PAC ID: 5395154694 Enrollment ID: I20210517000714 |
| Provider Name | Lizette V Leon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184379547 PECOS PAC ID: 3779978242 Enrollment ID: I20220318002159 |
| Provider Name | Stephanie M Villarreal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558077453 PECOS PAC ID: 7113392283 Enrollment ID: I20230404001563 |
| Provider Name | Kelsey P. Tevik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609641885 PECOS PAC ID: 4789022278 Enrollment ID: I20240403000951 |
Philip K Mccullough Md Sc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Huron St, Suite 11-100, Chicago, IL 60611 Phone: 312-695-3680 Fax: 312-926-3709 | |
Amy Lynn, Lcpc, Atr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3020 N Lincoln Ave, Flourish Studios, Chicago, IL 60657 Phone: 773-746-7429 | |
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