| Innovative Platinum Care, Sc | |
|
2400 N Ashland Ave Suite 150 Chicago IL 60614-2021 | |
| (773) 270-5600 | |
| (773) 360-7378 |
| Full Name | Innovative Platinum Care, Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 2400 N Ashland Ave, Chicago, Illinois |
| Authorized Official Name and Position | Rahul Khare (PRESIDENT) |
| Authorized Official Contact | 7732705600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Platinum Care, Sc 2400 N Ashland Ave Suite 150 Chicago IL 60614-2021 Ph: (773) 270-5600 | Innovative Platinum Care, Sc 2400 N Ashland Ave Suite 150 Chicago IL 60614-2021 Ph: (773) 270-5600 |
| NPI Number | 1114397056 |
|---|---|
| Provider Enumeration Date | 10/05/2015 |
| Last Update Date | 01/12/2016 |
| Medicare PECOS PAC ID | 7012210461 |
|---|---|
| Medicare Enrollment ID | O20160120000044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114397056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 36111153 (Illinois) | Primary |
| Provider Name | Jeffrey H Bohmer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609951979 PECOS PAC ID: 6204807308 Enrollment ID: I20040803000723 |
| Provider Name | Rahul Khare |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043248743 PECOS PAC ID: 3870562002 Enrollment ID: I20040924001022 |
| Provider Name | Renata C Gazzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710152301 PECOS PAC ID: 7214009992 Enrollment ID: I20080714000056 |
| Provider Name | John L Zautcke |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316046352 PECOS PAC ID: 9335279850 Enrollment ID: I20100610000224 |
| Provider Name | Audrey L Tanksley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750524518 PECOS PAC ID: 8123277431 Enrollment ID: I20121002000288 |
| Provider Name | Rinku H Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528325321 PECOS PAC ID: 0345550984 Enrollment ID: I20151110002161 |
| Provider Name | Elaine Cabugason |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386987238 PECOS PAC ID: 0941501654 Enrollment ID: I20160818000467 |
| Provider Name | Matthew J Vasey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982075313 PECOS PAC ID: 5890076087 Enrollment ID: I20161230000544 |
| Provider Name | Manan Trivedi |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1194067298 PECOS PAC ID: 5294045621 Enrollment ID: I20180731000532 |
| Provider Name | Karolyn Gayle Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134610942 PECOS PAC ID: 6901143577 Enrollment ID: I20190122001006 |
| Provider Name | Paulianne B Gonzales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679083471 PECOS PAC ID: 0547501652 Enrollment ID: I20190417001683 |
| Provider Name | Brian R Czapko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245793488 PECOS PAC ID: 6800138090 Enrollment ID: I20190509001108 |
| Provider Name | Steven Broderick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164877882 PECOS PAC ID: 7719212950 Enrollment ID: I20190711000065 |
| Provider Name | Megan Crisham |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265741268 PECOS PAC ID: 5991138695 Enrollment ID: I20191211001646 |
| Provider Name | Arin Szuch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801305057 PECOS PAC ID: 5193155968 Enrollment ID: I20200417002488 |
| Provider Name | Joanna N Godlewska |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922561794 PECOS PAC ID: 6507268422 Enrollment ID: I20210714001320 |
| Provider Name | Meredith L Villarreal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366819401 PECOS PAC ID: 2365752037 Enrollment ID: I20210716000516 |
| Provider Name | Farah Ahmed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346734050 PECOS PAC ID: 6800299181 Enrollment ID: I20210723001883 |
| Provider Name | Emily Kearney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649833641 PECOS PAC ID: 7719382480 Enrollment ID: I20210818000793 |
| Provider Name | Krishna Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588231120 PECOS PAC ID: 6406240415 Enrollment ID: I20220308000512 |
| Provider Name | Monica Medrano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821655663 PECOS PAC ID: 4082949433 Enrollment ID: I20220721002687 |
| Provider Name | Tuong Khanh Quy Le |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952971301 PECOS PAC ID: 7113394859 Enrollment ID: I20221109000862 |
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