Provider Demographics
NPI:1275004442
Name:CARITAS PHYSICIANS GROUP
Entity Type:Organization
Organization Name:CARITAS PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS AND CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSECA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-572-8228
Mailing Address - Street 1:1301 WEST 22ND STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-572-8228
Mailing Address - Fax:630-572-0566
Practice Address - Street 1:140 NORTH ASHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607
Practice Address - Country:US
Practice Address - Phone:312-850-9411
Practice Address - Fax:312-850-3288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARITAS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-16
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0023Medicaid