| Innovative Platinum Care, SC | |
|
2400 N Ashland Ave Suite 150 Chicago IL 60614-2021 | |
| (773) 270-5600 | |
| (773) 360-7378 |
| Full Name | Innovative Platinum Care, SC |
|---|---|
| Speciality | Family Medicine |
| Location | 2400 N Ashland Ave, Chicago, Illinois |
| Authorized Official Name and Position | Rahul Khare (PRESIDENT) |
| Authorized Official Contact | 7732705600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Platinum Care, SC 2400 N Ashland Ave Suite 150 Chicago IL 60614-2021 Ph: (773) 270-5600 | Innovative Platinum Care, SC 2400 N Ashland Ave Suite 150 Chicago IL 60614-2021 Ph: (773) 270-5600 |
| NPI Number | 1114397056 |
|---|---|
| Provider Enumeration Date | 10/05/2015 |
| Last Update Date | 01/12/2016 |
| Medicare PECOS PAC ID | 7012210461 |
|---|---|
| Medicare Enrollment ID | O20160120000044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114397056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 36111153 (Illinois) | Primary |
| Provider Name | Jeffrey H Bohmer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609951979 PECOS PAC ID: 6204807308 Enrollment ID: I20040803000723 |
| Provider Name | Rahul Khare |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043248743 PECOS PAC ID: 3870562002 Enrollment ID: I20040924001022 |
| Provider Name | James G Nee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932159282 PECOS PAC ID: 4880622828 Enrollment ID: I20050801000069 |
| Provider Name | Renata C Gazzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710152301 PECOS PAC ID: 7214009992 Enrollment ID: I20080714000056 |
| Provider Name | James M Arons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558351643 PECOS PAC ID: 7416963145 Enrollment ID: I20100326000837 |
| Provider Name | John L Zautcke |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316046352 PECOS PAC ID: 9335279850 Enrollment ID: I20100610000224 |
| Provider Name | Nadya M Modlin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1063721264 PECOS PAC ID: 2860687415 Enrollment ID: I20110407000786 |
| Provider Name | Jayme L Sibley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346521770 PECOS PAC ID: 5799950432 Enrollment ID: I20111208000436 |
| Provider Name | Audrey L Tanksley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750524518 PECOS PAC ID: 8123277431 Enrollment ID: I20121002000288 |
| Provider Name | Marla D Kushner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538119268 PECOS PAC ID: 5395973853 Enrollment ID: I20140109000254 |
| Provider Name | Jenna M Benoit |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1790110666 PECOS PAC ID: 8426281072 Enrollment ID: I20140506000396 |
| Provider Name | Alexis F Davidman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1679950232 PECOS PAC ID: 5294040747 Enrollment ID: I20150813009961 |
| Provider Name | Rinku H Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528325321 PECOS PAC ID: 0345550984 Enrollment ID: I20151110002161 |
| Provider Name | Michelle E Nagel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1033580865 PECOS PAC ID: 7214230911 Enrollment ID: I20160128002496 |
| Provider Name | Elaine Cabugason |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386987238 PECOS PAC ID: 0941501654 Enrollment ID: I20160818000467 |
| Provider Name | Arielle Douglas |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1093216855 PECOS PAC ID: 0840553426 Enrollment ID: I20180412001506 |
| Provider Name | Manan Trivedi |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1194067298 PECOS PAC ID: 5294045621 Enrollment ID: I20180731000532 |
| Provider Name | Jamie E Hitro |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356828230 PECOS PAC ID: 9638428063 Enrollment ID: I20180820000015 |
| Provider Name | Paulianne B Gonzales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679083471 PECOS PAC ID: 0547501652 Enrollment ID: I20190417001683 |
| Provider Name | Steven Broderick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164877882 PECOS PAC ID: 7719212950 Enrollment ID: I20190711000065 |
| Provider Name | Saba Khan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1376856187 PECOS PAC ID: 5890127187 Enrollment ID: I20191106002635 |
| Provider Name | Maxwell Arons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558718809 PECOS PAC ID: 4789017674 Enrollment ID: I20191206001991 |
| Provider Name | Megan Crisham |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265741268 PECOS PAC ID: 5991138695 Enrollment ID: I20191211001646 |
| Provider Name | Robert W Radtke |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619512019 PECOS PAC ID: 5395170310 Enrollment ID: I20200122001696 |
| Provider Name | Markus P Wrobel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1669093928 PECOS PAC ID: 6901215086 Enrollment ID: I20210430000768 |
| Provider Name | Megan Patricia Luedtke |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942802517 PECOS PAC ID: 9436558004 Enrollment ID: I20210602000699 |
| Provider Name | Emma L Raider |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1659903359 PECOS PAC ID: 9133529977 Enrollment ID: I20210615002998 |
| Provider Name | Dulguun Uyenbat |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881222354 PECOS PAC ID: 2961802780 Enrollment ID: I20210616001944 |
| Provider Name | Joanna N Godlewska |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922561794 PECOS PAC ID: 6507268422 Enrollment ID: I20210714001320 |
| Provider Name | Meredith L Villarreal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366819401 PECOS PAC ID: 2365752037 Enrollment ID: I20210716000516 |
| Provider Name | Lindsey M Ashley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1700210473 PECOS PAC ID: 7911135041 Enrollment ID: I20210716000870 |
| Provider Name | Farah Ahmed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346734050 PECOS PAC ID: 6800299181 Enrollment ID: I20210723001883 |
| Provider Name | Alli J Chemmachel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629695333 PECOS PAC ID: 1951704279 Enrollment ID: I20210723003165 |
| Provider Name | Sana Hira |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336775428 PECOS PAC ID: 3971991852 Enrollment ID: I20211026001617 |
| Provider Name | William J Hiatt |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1659981694 PECOS PAC ID: 2860881679 Enrollment ID: I20211117001439 |
| Provider Name | Marcus L Forward |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336767292 PECOS PAC ID: 7214328491 Enrollment ID: I20211222002577 |
| Provider Name | Krishna Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588231120 PECOS PAC ID: 6406240415 Enrollment ID: I20220308000512 |
| Provider Name | Asmabanu Patel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831722347 PECOS PAC ID: 2860879103 Enrollment ID: I20220506001580 |
| Provider Name | Apeksha Kishore |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1871238410 PECOS PAC ID: 0547640492 Enrollment ID: I20220708002533 |
| Provider Name | Julia Sangiovanni |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184288722 PECOS PAC ID: 3375953581 Enrollment ID: I20220718001797 |
| Provider Name | Monica Medrano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821655663 PECOS PAC ID: 4082949433 Enrollment ID: I20220721002687 |
| Provider Name | Madison N Stillwell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1407474463 PECOS PAC ID: 9032591680 Enrollment ID: I20220729001155 |
| Provider Name | Margarita Ruiz |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194998237 PECOS PAC ID: 0143605501 Enrollment ID: I20220921001339 |
| Provider Name | Nicole Catherine Loehr |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1396374120 PECOS PAC ID: 9133505258 Enrollment ID: I20220927002873 |
| Provider Name | Katherine Washagan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1174279020 PECOS PAC ID: 4183090640 Enrollment ID: I20221025001405 |
| Provider Name | Tuong Khanh Quy Le |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952971301 PECOS PAC ID: 7113394859 Enrollment ID: I20221109000862 |
| Provider Name | Julia Nellamattom |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1730890468 PECOS PAC ID: 9335508985 Enrollment ID: I20230629003829 |
| Provider Name | Myah Elizabeth Anderson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1497433320 PECOS PAC ID: 7911360599 Enrollment ID: I20230830000358 |
| Provider Name | Carly Babis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1679090625 PECOS PAC ID: 0446593628 Enrollment ID: I20230912002857 |
| Provider Name | Corey a Shuck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255086096 PECOS PAC ID: 3870038359 Enrollment ID: I20240709001165 |
| Provider Name | Asia Amin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932979085 PECOS PAC ID: 9638603939 Enrollment ID: I20241108002414 |
| Provider Name | Jasmine Lee Royal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922734607 PECOS PAC ID: 9537685532 Enrollment ID: I20250501002549 |
| Provider Name | Mayson Lyn Marcy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1134828221 PECOS PAC ID: 9133580954 Enrollment ID: I20250905001191 |
| Provider Name | Brynn Christensen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1285440305 PECOS PAC ID: 2860995339 Enrollment ID: I20250911000876 |
| Provider Name | Neda M. Svrakic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629719620 PECOS PAC ID: 0941797740 Enrollment ID: I20251015001929 |
| Provider Name | Kelly Lynn Connolly |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023718822 PECOS PAC ID: 2961865837 Enrollment ID: I20251015003290 |
| Provider Name | Nithin Charlly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831849744 PECOS PAC ID: 6709264526 Enrollment ID: I20251222001349 |
| Provider Name | Amanda Corral |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942974647 PECOS PAC ID: 4486037876 Enrollment ID: I20260420002348 |
| Provider Name | Juliet Gutierrez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245852086 PECOS PAC ID: 0840766325 Enrollment ID: I20260421003910 |
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