| Beloved Community Family Wellness Center | |
|
6821 S Halsted St Chicago IL 60621-1833 | |
| (773) 765-1382 | |
| (773) 651-3648 |
| Full Name | Beloved Community Family Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 6821 S Halsted St, Chicago, Illinois |
| Authorized Official Name and Position | Margie Johnson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7736513828 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beloved Community Family Wellness Center 326 W 64th St Chicago IL 60621-3114 Ph: (773) 651-3828 | Beloved Community Family Wellness Center 6821 S Halsted St Chicago IL 60621-1833 Ph: (773) 765-1382 |
| NPI Number | 1760408439 |
|---|---|
| Provider Enumeration Date | 07/14/2006 |
| Last Update Date | 10/20/2011 |
| Medicare PECOS PAC ID | 0042216038 |
|---|---|
| Medicare Enrollment ID | O20061016000042 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760408439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 261QP2300X (Illinois) | Primary |
| Provider Name | Benjamin G Calayag |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609969138 PECOS PAC ID: 2769424464 Enrollment ID: I20050524000083 |
| Provider Name | Ramon Flores |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1508882846 PECOS PAC ID: 8325053879 Enrollment ID: I20060220000616 |
| Provider Name | Anjum Zaheer Khan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1437232048 PECOS PAC ID: 5294733408 Enrollment ID: I20061127000089 |
| Provider Name | Clarence P Abella |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962513523 PECOS PAC ID: 1355491747 Enrollment ID: I20090605000040 |
| Provider Name | Reginald Nnamdi Okagbue |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235309352 PECOS PAC ID: 0244426914 Enrollment ID: I20101119000572 |
| Provider Name | Abina Goncalves |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154345635 PECOS PAC ID: 6608056387 Enrollment ID: I20110214000059 |
| Provider Name | Eva K Dumasia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588959050 PECOS PAC ID: 2769657998 Enrollment ID: I20111215000903 |
| Provider Name | Vernedia A Slaughter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932483906 PECOS PAC ID: 8022284470 Enrollment ID: I20120105000909 |
| Provider Name | Heather M Harrison |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497929798 PECOS PAC ID: 5193969525 Enrollment ID: I20131213000727 |
| Provider Name | Sheriva Hunter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295137842 PECOS PAC ID: 7113148958 Enrollment ID: I20141021001212 |
| Provider Name | Reneau A Diallo |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1578657862 PECOS PAC ID: 9739406281 Enrollment ID: I20150323001629 |
| Provider Name | Paul G Ngumi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013185693 PECOS PAC ID: 6800117573 Enrollment ID: I20150605001984 |
| Provider Name | Ella Cecilia C Heras |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205217312 PECOS PAC ID: 5294042859 Enrollment ID: I20150914002891 |
| Provider Name | Tyra Bernice Franklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295106268 PECOS PAC ID: 6901107895 Enrollment ID: I20151218000233 |
| Provider Name | Shenell E Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316304637 PECOS PAC ID: 8921306119 Enrollment ID: I20160421001531 |
| Provider Name | Lanesia Cephus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598120719 PECOS PAC ID: 8426357591 Enrollment ID: I20160425001930 |
| Provider Name | Stephanie M Liggons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053855908 PECOS PAC ID: 1557642915 Enrollment ID: I20161227001746 |
| Provider Name | Luming Feng |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013202142 PECOS PAC ID: 9638496128 Enrollment ID: I20170823002667 |
| Provider Name | Alecia S Jefferson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811281306 PECOS PAC ID: 6709145204 Enrollment ID: I20180108002707 |
| Provider Name | Asha Mosi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386180735 PECOS PAC ID: 1456609957 Enrollment ID: I20180731001429 |
| Provider Name | Rosa D Bellido Griffin |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1649484353 PECOS PAC ID: 4183911522 Enrollment ID: I20190412001581 |
| Provider Name | Karnesha Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548611791 PECOS PAC ID: 1456680255 Enrollment ID: I20190904000107 |
| Provider Name | Katherine M Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750939476 PECOS PAC ID: 6204166671 Enrollment ID: I20190927000191 |
| Provider Name | Vonnise R Hussey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902379621 PECOS PAC ID: 5698007805 Enrollment ID: I20191021002221 |
| Provider Name | Dorian Norwood-turner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306318233 PECOS PAC ID: 1355673757 Enrollment ID: I20191105001630 |
| Provider Name | Bukola Odusote |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124670948 PECOS PAC ID: 0840622577 Enrollment ID: I20191118001455 |
| Provider Name | Annalaura Goodman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093088379 PECOS PAC ID: 5890079032 Enrollment ID: I20191119002200 |
| Provider Name | Austin P Tyus-michalak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932748506 PECOS PAC ID: 1658706486 Enrollment ID: I20200124000050 |
| Provider Name | Daniel Marth |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1326569286 PECOS PAC ID: 6709292527 Enrollment ID: I20210302003206 |
| Provider Name | Julianna Blaj |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275186009 PECOS PAC ID: 5395151088 Enrollment ID: I20210303003055 |
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