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PROGRESSIVE MEDICAL CENTER SC NPI 1629128319


NPI Information

NPI: 1629128319
Provider Name: PROGRESSIVE MEDICAL CENTER SC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 14D0885998

Address:
414 W LAKE STREET
ADDISON, IL
ZIP 60101
Phone: (630) 458-1905
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PROGRESSIVE MEDICAL CENTER SC is an internal medicine in Addison, IL. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. PROGRESSIVE MEDICAL CENTER SC NPI is 1629128319. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

414 W LAKE STREET
ADDISON, IL
ZIP 60101
Phone: (630) 458-1905
Fax: (630) 458-1908

The provider's authorized official is Gabriela Henriquez .
The authorized official title is Office Manager and has the following contact phone number (630) 238-9235.

The CLIA number assigned to this NPI record is 14D0885998 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/12/2007 and was last updated on 4/7/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine036103673ILLINOISNo
2207Q00000XFamily Medicine036107571ILLINOISNo
3208000000XPediatrics036078267ILLINOISNo
4207R00000XInternal Medicine036087152ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1352610MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
2373120MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
3K14000MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
4036103673MEDICAIDILLINOIS
5036109448MEDICAIDILLINOIS
6110153602MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
7036078267MEDICAIDILLINOIS
8G05846MEDICARE UPINILLINOIS
9937192MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
10110153600MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
11036087152MEDICAIDILLINOIS
12H53956MEDICARE UPINILLINOIS
13I24586MEDICARE UPINILLINOIS
14E40859MEDICARE UPINILLINOIS
15CF9448MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
162205538OTHERILLINOISBCBS OF ILLINOIS
17P00311497MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
18200566MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
19=========OTHERILLINOISTAX ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.