CENTEGRA PRIMARY CARE LLC NPI 1700905205

NPI Information

NPI: 1700905205
Provider Name: CENTEGRA PRIMARY CARE, LLC

Doing Business As: CENTEGRA PHYSICIAN CARE, LLC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
13707 W JACKSON ST
WOODSTOCK, IL
ZIP 60098
Phone: (815) 337-2890
Get Directions

CENTEGRA PRIMARY CARE, LLC is a family medicine in Woodstock, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CENTEGRA PRIMARY CARE, LLC NPI is 1700905205. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Centegra Physician Care, Llc.

The provider's business location address is:

13707 W JACKSON ST
WOODSTOCK, IL
ZIP 60098-188
Phone: (815) 337-2890
Fax: (815) 338-6297

The provider's authorized official is David Tomlinson .
The authorized official title is Cio & Cfo and has the following contact phone number (815) 788-5831.

The enumeration date for this NPI number is 3/28/2007 and was last updated on 3/21/2014.

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 Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207R00000X	Internal Medicine		No
2	207RE0101X	Internal Medicine	Endocrinology, Diabetes & Metabolism	No
3	207RR0500X	Internal Medicine	Rheumatology	No
4	207V00000X	Obstetrics & Gynecology		No
5	208000000X	Pediatrics		No
6	363L00000X	Nurse Practitioner		No
7	363LA2200X	Nurse Practitioner	Adult Health	No
8	363LF0000X	Nurse Practitioner	Family	No
9	363LP0200X	Nurse Practitioner	Pediatrics	No
10	207Q00000X	Family Medicine		Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	209584	OTHER	ILLINOIS	MEDICARE GROUP
2	962341	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS	MEDICARE
3	CC7412	OTHER	ILLINOIS	MEDICARE RAILROAD

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: 5/5/2024

NPI Synchronization or Removal

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