| Physician Care At Home Management Company Llc | |
|
1026 N Main St Rochelle IL 61068-1712 | |
| (773) 307-2648 | |
| (773) 942-7454 |
| Full Name | Physician Care At Home Management Company Llc |
|---|---|
| Speciality | General Practice |
| Location | 1026 N Main St, Rochelle, Illinois |
| Authorized Official Name and Position | Connie Perez (OFFICE MANAGER) |
| Authorized Official Contact | 7733072648 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician Care At Home Management Company Llc 1026 N Main St Rochelle IL 61068-1712 Ph: (773) 307-2648 | Physician Care At Home Management Company Llc 1026 N Main St Rochelle IL 61068-1712 Ph: (773) 307-2648 |
| NPI Number | 1114458791 |
|---|---|
| Provider Enumeration Date | 03/24/2017 |
| Last Update Date | 08/09/2021 |
| Medicare PECOS PAC ID | 7911274170 |
|---|---|
| Medicare Enrollment ID | O20170519000324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114458791 | NPI | - | NPPES |
| 036099959 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Lori M Riley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629160965 PECOS PAC ID: 5799709945 Enrollment ID: I20070515000077 |
| Provider Name | Julie A Austin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144430323 PECOS PAC ID: 2567514235 Enrollment ID: I20090710000566 |
| Provider Name | Kamran Khatri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821441619 PECOS PAC ID: 3375839178 Enrollment ID: I20160902000982 |
| Provider Name | Jocelyn T Go |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205346467 PECOS PAC ID: 3173899481 Enrollment ID: I20171031002168 |
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