Lifestyle Rejuvenation Medical Group Pllc is a medicare enrolled "Clinic/center - Multi-specialty" provider in Chicago, Illinois. Their current practice location is
1740 E 55th Street, Chicago, Illinois. You can reach out to their office (for appointments etc.) via phone at
(773) 667-9053.
Lifestyle Rejuvenation Medical Group Pllc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Lifestyle Rejuvenation Medical Group Pllc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1134781974.
Healthcare Provider's Profile
| Full Name | Lifestyle Rejuvenation Medical Group Pllc |
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| Type | Facility |
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| Speciality | Clinic/center - Multi-specialty |
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| Location | 1740 E 55th Street, Chicago, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1134781974
- Provider Enumeration Date: 07/02/2019
- Last Update Date: 05/29/2020
Medicare PECOS Information:
- PECOS PAC ID: 2163841966
- Enrollment ID: O20200929000051
Medical Identifiers
Medical identifiers for Lifestyle Rejuvenation Medical Group Pllc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1134781974 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111N00000X | Chiropractor | (* (Not Available)) | Secondary |
| 111NR0400X | Chiropractor - Rehabilitation | (* (Not Available)) | Secondary |
| 261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QP3300X | Clinic/center - Pain | (* (Not Available)) | Secondary |
| 261QR0200X | Clinic/center - Radiology | (* (Not Available)) | Secondary |
| 261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Secondary |
| 261QR0800X | Clinic/center - Recovery Care | (* (Not Available)) | Secondary |
| 302R00000X | Health Maintenance Organization | (* (Not Available)) | Secondary |
| 305R00000X | Preferred Provider Organization | (* (Not Available)) | Secondary |
| 305S00000X | Point Of Service | (* (Not Available)) | Secondary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Lifestyle Rejuvenation Medical Group Pllc acts as a billing entity for following providers:
| Provider Name | Robert Van Higginbottom |
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| Provider Type | Practitioner - Chiropractic |
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| Provider Identifiers | NPI Number: 1659426336
PECOS PAC ID: 0547229155
Enrollment ID: I20041008000625 |
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| Provider Name | Silvia Nunez |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1598272023
PECOS PAC ID: 4486918208
Enrollment ID: I20180503000001 |
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| Provider Name | Dolorita Onguru |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1831664127
PECOS PAC ID: 7618212358
Enrollment ID: I20181227000719 |
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| Provider Name | Lisa Kay Kracinski |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1487286548
PECOS PAC ID: 0244669612
Enrollment ID: I20200406002437 |
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| Provider Name | Racheal Ann Feliz |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1063097343
PECOS PAC ID: 4789052291
Enrollment ID: I20221114003156 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lifestyle Rejuvenation Medical Group Pllc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Lifestyle Rejuvenation Medical Group Pllc
1740 E 55th St,
Chicago, IL 60615-5966
Ph: (773) 667-9053 | Lifestyle Rejuvenation Medical Group Pllc
1740 E 55th Street,
Chicago, IL 60615
Ph: (773) 667-9053 |
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