| Primecare Community Health, Inc. | |
|
1431 N Western Ave Suite 401 Chicago IL 60622-1797 | |
| (312) 633-5841 | |
| (312) 491-5485 |
| Full Name | Primecare Community Health, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1431 N Western Ave, Chicago, Illinois |
| Authorized Official Name and Position | Joseph Moldovan (COO/CFO) |
| Authorized Official Contact | 3124915034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primecare Community Health, Inc. 1431 N Western Ave Suite 401 Chicago IL 60622-1797 Ph: (312) 633-5841 | Primecare Community Health, Inc. 1431 N Western Ave Suite 401 Chicago IL 60622-1797 Ph: (312) 633-5841 |
| NPI Number | 1558532739 |
|---|---|
| Provider Enumeration Date | 03/17/2008 |
| Last Update Date | 10/26/2016 |
| Medicare PECOS PAC ID | 6204722077 |
|---|---|
| Medicare Enrollment ID | O20040227000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558532739 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Stephen S Stabile |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295756344 PECOS PAC ID: 6507754751 Enrollment ID: I20040309000426 |
| Provider Name | James E Lang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780668251 PECOS PAC ID: 0941198105 Enrollment ID: I20040309000528 |
| Provider Name | Michael H Friedman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487638953 PECOS PAC ID: 2062300288 Enrollment ID: I20040309000874 |
| Provider Name | Mark T Simon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811078793 PECOS PAC ID: 7517952161 Enrollment ID: I20040415000014 |
| Provider Name | Celine A Boers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750382032 PECOS PAC ID: 9133100316 Enrollment ID: I20040525000688 |
| Provider Name | Blanca M Baldoceda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871533703 PECOS PAC ID: 0941240873 Enrollment ID: I20050510000483 |
| Provider Name | Alicia Vazquez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912028192 PECOS PAC ID: 4082622865 Enrollment ID: I20060405000481 |
| Provider Name | Sandra Z Anderson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669541868 PECOS PAC ID: 1850399700 Enrollment ID: I20061201000201 |
| Provider Name | Juliet L Bradley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629087523 PECOS PAC ID: 0749382422 Enrollment ID: I20070227000294 |
| Provider Name | Alicia A Milan Flanigan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760695779 PECOS PAC ID: 2163519869 Enrollment ID: I20071026000726 |
| Provider Name | Scott B Phillips |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1053369967 PECOS PAC ID: 1355418021 Enrollment ID: I20080922000450 |
| Provider Name | Roohi U Wasiuddin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1265629786 PECOS PAC ID: 6002977543 Enrollment ID: I20081203000152 |
| Provider Name | Arlene M Wallace |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1699858878 PECOS PAC ID: 1759434574 Enrollment ID: I20090727000564 |
| Provider Name | Kate K Gunnell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164470670 PECOS PAC ID: 8628108818 Enrollment ID: I20100615000380 |
| Provider Name | Jim A Christoforidis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578546222 PECOS PAC ID: 2062544117 Enrollment ID: I20100726000108 |
| Provider Name | Elias Murciano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568445112 PECOS PAC ID: 5395878334 Enrollment ID: I20100728000566 |
| Provider Name | Young H Mok |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1124029277 PECOS PAC ID: 1153347463 Enrollment ID: I20101012000095 |
| Provider Name | Brigid C Andrew |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1851482673 PECOS PAC ID: 8628258829 Enrollment ID: I20110204000559 |
| Provider Name | Sara Huezo Funes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225279979 PECOS PAC ID: 1557533668 Enrollment ID: I20111014000458 |
| Provider Name | Jose L Huerta Suarez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407089394 PECOS PAC ID: 3173779576 Enrollment ID: I20120816000698 |
| Provider Name | Maria D Ariza Altahona |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073746871 PECOS PAC ID: 3577719988 Enrollment ID: I20120816000898 |
| Provider Name | Marianne K Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518228915 PECOS PAC ID: 0648427799 Enrollment ID: I20120824000843 |
| Provider Name | Jeanine C Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518287812 PECOS PAC ID: 1254565245 Enrollment ID: I20131007000092 |
| Provider Name | David M Salas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508203928 PECOS PAC ID: 7416181409 Enrollment ID: I20131007000144 |
| Provider Name | Stephanie E Place |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336460807 PECOS PAC ID: 0547494338 Enrollment ID: I20131010000522 |
| Provider Name | Sandeep S Randhawa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083935134 PECOS PAC ID: 8426282898 Enrollment ID: I20131018000745 |
| Provider Name | Dorothy A Dschida |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164743241 PECOS PAC ID: 1254566649 Enrollment ID: I20131018001393 |
| Provider Name | Paulette Y Jarrett-rodney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861826604 PECOS PAC ID: 1456574607 Enrollment ID: I20140516000210 |
| Provider Name | Luke Joshua Heitz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043508575 PECOS PAC ID: 3173741089 Enrollment ID: I20140905000600 |
| Provider Name | Rebecca Resendiz Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437469574 PECOS PAC ID: 8921308180 Enrollment ID: I20151120000433 |
| Provider Name | Bridget Nord |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538435763 PECOS PAC ID: 8325348105 Enrollment ID: I20151201000337 |
| Provider Name | Claudia Sanchez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841556867 PECOS PAC ID: 0446550016 Enrollment ID: I20151203002351 |
| Provider Name | Javier Guevara |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346504867 PECOS PAC ID: 1456651942 Enrollment ID: I20151207001135 |
| Provider Name | Andrea J Kuebbeler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558722074 PECOS PAC ID: 5597063560 Enrollment ID: I20160408000218 |
| Provider Name | Abigail L Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659717841 PECOS PAC ID: 1557660537 Enrollment ID: I20161017002138 |
| Provider Name | Mayra A Bailon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700234630 PECOS PAC ID: 9234427642 Enrollment ID: I20161017002634 |
| Provider Name | Ricardo Aguinaga |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215187661 PECOS PAC ID: 0749568475 Enrollment ID: I20161031001242 |
| Provider Name | Kathryn E Sas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639597560 PECOS PAC ID: 2567744634 Enrollment ID: I20170125001004 |
| Provider Name | Dana A Kroop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437558541 PECOS PAC ID: 7517284706 Enrollment ID: I20171026003167 |
| Provider Name | Anna Jaroszewska |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588071294 PECOS PAC ID: 3779873013 Enrollment ID: I20171027002225 |
| Provider Name | David Cardona-jiminez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679829535 PECOS PAC ID: 7214228378 Enrollment ID: I20190408000955 |
| Provider Name | Alejandro Luis Acevedo Hernandez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558590224 PECOS PAC ID: 1951612894 Enrollment ID: I20190503001643 |
| Provider Name | Liz Franco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992354195 PECOS PAC ID: 3577894500 Enrollment ID: I20191007000207 |
| Provider Name | Karen O' Connor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538512280 PECOS PAC ID: 9032471214 Enrollment ID: I20191009000707 |
| Provider Name | Alyssa Pearlstein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144882259 PECOS PAC ID: 2264764851 Enrollment ID: I20191031001687 |
| Provider Name | Bharathi Jayaram |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417285958 PECOS PAC ID: 0143656496 Enrollment ID: I20200204001748 |
| Provider Name | Antonio Wheeler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356980486 PECOS PAC ID: 7416386636 Enrollment ID: I20200408003966 |
| Provider Name | Clemen Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609302900 PECOS PAC ID: 4880954031 Enrollment ID: I20200722000979 |
| Provider Name | Beata Staszewski |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881108579 PECOS PAC ID: 3173940897 Enrollment ID: I20200826002674 |
| Provider Name | Paul Brodzik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871015214 PECOS PAC ID: 0648533562 Enrollment ID: I20200914000309 |
| Provider Name | Christina Marmol |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982145280 PECOS PAC ID: 5193096584 Enrollment ID: I20200929002632 |
| Provider Name | Wenfei Yang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912558495 PECOS PAC ID: 4082048087 Enrollment ID: I20201208000790 |
| Provider Name | Hannah Polus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376072009 PECOS PAC ID: 2769755040 Enrollment ID: I20210107001632 |
| Provider Name | Aida Luz Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295331528 PECOS PAC ID: 3577976257 Enrollment ID: I20210120000467 |
| Provider Name | Matthew Q English |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417546607 PECOS PAC ID: 8527475615 Enrollment ID: I20210408001044 |
| Provider Name | Joanna N Godlewska |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922561794 PECOS PAC ID: 6507268422 Enrollment ID: I20210714001320 |
| Provider Name | Paula Zafra Acosta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902399306 PECOS PAC ID: 7416204375 Enrollment ID: I20210716000091 |
| Provider Name | Lindsey Harrigan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972278620 PECOS PAC ID: 7416355383 Enrollment ID: I20211006002617 |
| Provider Name | Shawn Decker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639533771 PECOS PAC ID: 9537567375 Enrollment ID: I20211118000482 |
| Provider Name | Vera Lucia Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245985241 PECOS PAC ID: 9537554811 Enrollment ID: I20220323002366 |
| Provider Name | Danique Lippens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821650961 PECOS PAC ID: 3577898923 Enrollment ID: I20220629000667 |
| Provider Name | Dagni Coromoto Chuki Naguanagua |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366001133 PECOS PAC ID: 4082949458 Enrollment ID: I20220919002539 |
| Provider Name | Marisa A Carter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649838384 PECOS PAC ID: 0749515104 Enrollment ID: I20230125002519 |
| Provider Name | Richard Cucinotta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316680945 PECOS PAC ID: 5799141230 Enrollment ID: I20230525001466 |
| Provider Name | Carlos Echevarria |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215520044 PECOS PAC ID: 8022424175 Enrollment ID: I20230626001737 |
| Provider Name | Rachel Richard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821775495 PECOS PAC ID: 5597128926 Enrollment ID: I20230831003192 |
| Provider Name | Christine Knight |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114540697 PECOS PAC ID: 1153745328 Enrollment ID: I20230927000995 |
| Provider Name | Monika Borkowska |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891273397 PECOS PAC ID: 0244679280 Enrollment ID: I20240423003474 |
| Provider Name | Gabriela Zaragoza |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134989965 PECOS PAC ID: 0648610717 Enrollment ID: I20240507000420 |
| Provider Name | Anne Christina Buenneke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437914678 PECOS PAC ID: 2264874999 Enrollment ID: I20240528001503 |
| Provider Name | Lasheena J. Clark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093941957 PECOS PAC ID: 0143662775 Enrollment ID: I20240528001606 |
| Provider Name | Melissa Guzicki |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609322353 PECOS PAC ID: 3577905108 Enrollment ID: I20240528001700 |
| Provider Name | Katarzyna Ciesielska |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740031772 PECOS PAC ID: 7214379858 Enrollment ID: I20240528002048 |
| Provider Name | Namrata Bhatt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598234262 PECOS PAC ID: 1355783978 Enrollment ID: I20240529001154 |
| Provider Name | Dana Murray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720502412 PECOS PAC ID: 0345682746 Enrollment ID: I20240530003801 |
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