| Chicagoland Physician Consortium, Llc | |
|
3510 W 79th St Chicago IL 60652-1430 | |
| (773) 459-9661 | |
| (312) 631-2892 |
| Full Name | Chicagoland Physician Consortium, Llc |
|---|---|
| Speciality | Hospitalist |
| Location | 3510 W 79th St, Chicago, Illinois |
| Authorized Official Name and Position | Rudyard U Smith (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7734599661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chicagoland Physician Consortium, Llc 3510 W 79th St Chicago IL 60652-1430 Ph: (773) 459-9661 | Chicagoland Physician Consortium, Llc 3510 W 79th St Chicago IL 60652-1430 Ph: (773) 459-9661 |
| NPI Number | 1720537384 |
|---|---|
| Provider Enumeration Date | 09/23/2016 |
| Last Update Date | 09/07/2017 |
| Medicare PECOS PAC ID | 7416230842 |
|---|---|
| Medicare Enrollment ID | O20170209001953 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720537384 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208M00000X | Hospitalist | (* (Not Available)) | Primary |
| Provider Name | Rudyard U Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295784031 PECOS PAC ID: 5698673937 Enrollment ID: I20031223000793 |
| Provider Name | Eden D Brandon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063605814 PECOS PAC ID: 5799870614 Enrollment ID: I20071005000702 |
| Provider Name | Sebastian Joseph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790004380 PECOS PAC ID: 0042342800 Enrollment ID: I20100715000051 |
| Provider Name | Steven Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114360013 PECOS PAC ID: 3779885975 Enrollment ID: I20160406001618 |
| Provider Name | Elaine Cabugason |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386987238 PECOS PAC ID: 0941501654 Enrollment ID: I20160818000467 |
| Provider Name | Cynthia A Brechum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467097998 PECOS PAC ID: 2769899814 Enrollment ID: I20210407002519 |
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