| Cermak Medical Group LLC | |
|
5741 W Cermak Rd Cicero IL 60804-2129 | |
| (708) 222-0100 | |
| (708) 222-0102 |
| Full Name | Cermak Medical Group LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 5741 W Cermak Rd, Cicero, Illinois |
| Authorized Official Name and Position | Ruchir Thakkar (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7082220100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cermak Medical Group LLC 5741 W Cermak Rd Cicero IL 60804-2129 Ph: (708) 222-0100 | Cermak Medical Group LLC 5741 W Cermak Rd Cicero IL 60804-2129 Ph: (708) 222-0100 |
| NPI Number | 1518498393 |
|---|---|
| Provider Enumeration Date | 03/23/2017 |
| Last Update Date | 01/25/2019 |
| Medicare PECOS PAC ID | 7113269242 |
|---|---|
| Medicare Enrollment ID | O20190422000151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518498393 | NPI | - | NPPES |
| 036133879 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036133879 (Illinois) | Primary |
| Provider Name | Angelina D Ledonne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407977838 PECOS PAC ID: 6305024365 Enrollment ID: I20110623000024 |
| Provider Name | Tracie Clisby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942574769 PECOS PAC ID: 3173779303 Enrollment ID: I20120803000415 |
| Provider Name | Filimon Ramos |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962738914 PECOS PAC ID: 7517004328 Enrollment ID: I20140911000906 |
| Provider Name | Ruchir L Thakkar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174812853 PECOS PAC ID: 2264654888 Enrollment ID: I20141117000023 |
| Provider Name | Wyvon L Blackwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821398397 PECOS PAC ID: 8123340403 Enrollment ID: I20141124001757 |
| Provider Name | Mohanjit K Gill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619371267 PECOS PAC ID: 7719209774 Enrollment ID: I20141201002123 |
| Provider Name | Erica E Simmons |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1104222611 PECOS PAC ID: 0446576995 Enrollment ID: I20150228000147 |
| Provider Name | Neil a Paulsen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1851799738 PECOS PAC ID: 9830417286 Enrollment ID: I20150414002472 |
| Provider Name | Lisa Evertsen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1659761567 PECOS PAC ID: 5193045227 Enrollment ID: I20150513001348 |
| Provider Name | Nichelle M Bush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447647110 PECOS PAC ID: 2365762291 Enrollment ID: I20150911001296 |
| Provider Name | Shima Chia |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1174921266 PECOS PAC ID: 8022325679 Enrollment ID: I20150915002753 |
| Provider Name | Victor C Okamgba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629434741 PECOS PAC ID: 8628372711 Enrollment ID: I20160210001753 |
| Provider Name | Jatame Carden |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831649029 PECOS PAC ID: 9638467095 Enrollment ID: I20161018001358 |
| Provider Name | Alex Joseph |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1669923280 PECOS PAC ID: 7719255140 Enrollment ID: I20170607002921 |
| Provider Name | Feng Wen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1154717916 PECOS PAC ID: 5395019871 Enrollment ID: I20170921002553 |
| Provider Name | David S Clark |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1487089645 PECOS PAC ID: 9032483409 Enrollment ID: I20170922003465 |
| Provider Name | Sonja Enge-gilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659823458 PECOS PAC ID: 3375818065 Enrollment ID: I20171005001800 |
| Provider Name | Jeanette T Varquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649789876 PECOS PAC ID: 5092071498 Enrollment ID: I20171116002761 |
| Provider Name | Ryan Miguel Colon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1134648389 PECOS PAC ID: 4981961844 Enrollment ID: I20171130001888 |
| Provider Name | Johanna C Montoya Castillo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1205348976 PECOS PAC ID: 3173882727 Enrollment ID: I20180105001416 |
| Provider Name | Andrea Pawlak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053898130 PECOS PAC ID: 9739439134 Enrollment ID: I20180905003609 |
| Provider Name | Jessica L Frith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073003463 PECOS PAC ID: 4880947902 Enrollment ID: I20181018003082 |
| Provider Name | Becky Manappuram |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1396128880 PECOS PAC ID: 0446537955 Enrollment ID: I20181201000197 |
| Provider Name | Nancy Quezada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649752023 PECOS PAC ID: 3779822242 Enrollment ID: I20190227001673 |
| Provider Name | Natalia Maria Zaparaniuk |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932616737 PECOS PAC ID: 6103151808 Enrollment ID: I20190717003689 |
| Provider Name | Julia a Edwards |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568022614 PECOS PAC ID: 1658609490 Enrollment ID: I20190819000693 |
| Provider Name | Gabriela Alexandra Velazquez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831754274 PECOS PAC ID: 8224366406 Enrollment ID: I20190826003730 |
| Provider Name | Tia Loftus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568014843 PECOS PAC ID: 6709117740 Enrollment ID: I20191007000836 |
| Provider Name | Kenneth James Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982052866 PECOS PAC ID: 6103111703 Enrollment ID: I20200817000385 |
| Provider Name | Robert J Mazalewski |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1841587540 PECOS PAC ID: 7012186703 Enrollment ID: I20201015003180 |
| Provider Name | Alvina Shaikh |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770120222 PECOS PAC ID: 4082034558 Enrollment ID: I20201022000371 |
| Provider Name | Kristen Ariel O'connell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1477169654 PECOS PAC ID: 3971986365 Enrollment ID: I20220817003506 |
| Provider Name | Andrea Mary Rego |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1417675323 PECOS PAC ID: 9234505603 Enrollment ID: I20221026002572 |
| Provider Name | Yekaterina S Noble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891404521 PECOS PAC ID: 3173993581 Enrollment ID: I20221229001770 |
| Provider Name | Erica Boston |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1396454641 PECOS PAC ID: 0648642181 Enrollment ID: I20230210000609 |
| Provider Name | Nicole Elizabeth Kula |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184333627 PECOS PAC ID: 1951773332 Enrollment ID: I20230213000759 |
| Provider Name | Viviana Quintana |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1124799929 PECOS PAC ID: 7911396676 Enrollment ID: I20230720001677 |
| Provider Name | Crystal Elena Estrada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720782154 PECOS PAC ID: 5698137818 Enrollment ID: I20230818002168 |
| Provider Name | Lauren S King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336923382 PECOS PAC ID: 9436506870 Enrollment ID: I20231107002865 |
| Provider Name | Mariola Grzeszczyk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003425463 PECOS PAC ID: 8628416344 Enrollment ID: I20240401001592 |
| Provider Name | Haley Rose Scheller |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437911039 PECOS PAC ID: 8123466752 Enrollment ID: I20240402002386 |
| Provider Name | Sofia Kamran |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386422319 PECOS PAC ID: 1951749019 Enrollment ID: I20240409001752 |
| Provider Name | Jacob James Luka |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083479414 PECOS PAC ID: 9032558168 Enrollment ID: I20240422002228 |
| Provider Name | Jacob Boehm |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932741717 PECOS PAC ID: 2769815224 Enrollment ID: I20240611000725 |
| Provider Name | Matthew Vaughn |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1679309959 PECOS PAC ID: 7214463496 Enrollment ID: I20241211001947 |
| Provider Name | Shannon G. Shipman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619788650 PECOS PAC ID: 9032630017 Enrollment ID: I20250306001532 |
| Provider Name | Jolly P Macwan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306551486 PECOS PAC ID: 9133583461 Enrollment ID: I20250317001005 |
| Provider Name | Brian Harvey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346763455 PECOS PAC ID: 3971867193 Enrollment ID: I20250507001987 |
| Provider Name | Malak Ayman Fares |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336612449 PECOS PAC ID: 9537687223 Enrollment ID: I20250516000740 |
| Provider Name | Atzel Albino Martinez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1174475719 PECOS PAC ID: 8123597887 Enrollment ID: I20260512003264 |
| Provider Name | Andrew Montoya |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1205784014 PECOS PAC ID: 2163992975 Enrollment ID: I20260521002770 |
| Provider Name | Alexis Rae Rivera |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1730038670 PECOS PAC ID: 6002386463 Enrollment ID: I20260527000863 |
Roselia Herrera MD SC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6039 W Cermak Rd, Cicero, IL 60804 Phone: 708-652-0056 |
MK Medical Group LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5729 W Cermak Rd, Cicero, IL 60804 Phone: 708-477-6525 |
Home Doctors, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1204 S 57th Ave, Cicero, IL 60804 Phone: 312-375-7145 Fax: 708-652-5424 |
Morton East Adolescent Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2423 S Austin Blvd, Cicero, IL 60804 Phone: 708-656-1130 |
Hernan Reyes MD SC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5610 W Cermak Rd, Unit #2, Cicero, IL 60804 Phone: 708-656-9247 Fax: 708-656-9358 |
Alivio Medical Center Cicero Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4842 W Cermak Rd, Cicero, IL 60804 Phone: 312-829-6304 Fax: 708-660-0349 |