ABRAHAM'S MARK COMPREHENSIVE WELLNESS CENTER, SC – Primary Care Clinic/Center, NPI 1104857341
Primary Care Clinic/Center
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for ABRAHAM'S MARK COMPREHENSIVE WELLNESS CENTER, SC
9500, South Dorchester Avenue, Cottage Grove Heights, Pullman, Chicago, Hyde Park Township, Cook County, Illinois, 60628, United States
SUITE 100
CHICAGO, IL 606281700
Phone: (773) 667-0768
Fax: (773) 667-5529
Type: Mailing
PO BOX 13677
BELFAST, ME 049154027
Phone: (773) 667-0768
Fax: (773) 667-5529
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-05-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-07-31 (682 days ago).
Enrollment records
1
Earliest due date
2024-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040512000597 | O | Clinic/Group Practice | IL | 2024-07-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60628)
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