Unknown Individual – Family Medicine Physician, NPI 1780648543
Family Medicine Physician
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NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
South Archer Avenue, Archer Heights, Chicago, Lake Township, Cook County, Illinois, 60632, United States
CHICAGO, IL 606381677
Phone: (773) 884-4150
Fax: (773) 884-4166
Type: Mailing
5680, South Archer Avenue, Garfield Ridge, Chicago, Lake Township, Cook County, Illinois, 60638, United States
CHICAGO, IL 606381659
Phone: (773) 884-4150
Fax: (773) 884-4166
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 100 | 20 | $0 |
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