| Tpa Network Incorporated | |
|
5537 N Broadway St Chicago IL 60640-1405 | |
| (773) 989-9400 | |
| (773) 989-9494 |
| Full Name | Tpa Network Incorporated |
|---|---|
| Speciality | Counselor |
| Location | 5537 N Broadway St, Chicago, Illinois |
| Authorized Official Name and Position | Tanya Mauldin (PROVIDER ENROLLMENT MANAGER) |
| Authorized Official Contact | 4142251611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tpa Network Incorporated Po Box 18412 Palatine IL 60055-0001 Ph: (866) 525-5414 | Tpa Network Incorporated 5537 N Broadway St Chicago IL 60640-1405 Ph: (773) 989-9400 |
| NPI Number | 1174896914 |
|---|---|
| Provider Enumeration Date | 02/09/2012 |
| Last Update Date | 05/14/2025 |
| Certification Date | 05/14/2025 |
| Medicare PECOS PAC ID | 9133565997 |
|---|---|
| Medicare Enrollment ID | O20240314003547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174896914 | NPI | - | NPPES |
| Provider Name | Corinne M Blum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699791400 PECOS PAC ID: 7911903901 Enrollment ID: I20061016000072 |
| Provider Name | John J Stryker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427281336 PECOS PAC ID: 0648406637 Enrollment ID: I20131121001296 |
| Provider Name | Amesika N Nyaku |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134440647 PECOS PAC ID: 6002037942 Enrollment ID: I20141018000150 |
| Provider Name | Dayna L Flores |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1538434212 PECOS PAC ID: 9739535030 Enrollment ID: I20231023002324 |
| Provider Name | Jo-ann Jose |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568722650 PECOS PAC ID: 8729365184 Enrollment ID: I20231226001372 |
| Provider Name | Christina Joly |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568007433 PECOS PAC ID: 4688020977 Enrollment ID: I20240314003694 |
| Provider Name | Erin M. Conley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811623580 PECOS PAC ID: 7719327295 Enrollment ID: I20240501000967 |
| Provider Name | Beverly Brock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548001019 PECOS PAC ID: 9638613946 Enrollment ID: I20240627002348 |
| Provider Name | Martha F Hernandez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528284452 PECOS PAC ID: 5799821666 Enrollment ID: I20240711002138 |
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