Provider Demographics
NPI:1740231505
Name:CARDIOVASCULAR ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHAMBERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-981-3680
Mailing Address - Street 1:900 S FRONTAGE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4903
Mailing Address - Country:US
Mailing Address - Phone:847-981-3680
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD RD STE G01
Practice Address - Street 2:WIMMER BUILDING
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3372
Practice Address - Country:US
Practice Address - Phone:847-981-3680
Practice Address - Fax:847-956-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL42007401207RC0000X, 207RC0001X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619483OtherBCBS
IL4478598OtherAETNA
IL1146003OtherUNITED HEALTHCARE
IL343940OtherLOCALITY 16
IL0503174OtherCIGNA
IL4478598OtherAETNA
IL519500Medicare ID - Type UnspecifiedLOCALITY 15
ILCM9413Medicare ID - Type UnspecifiedRAILROAD LOCALITY 16
IL1146003OtherUNITED HEALTHCARE
IL200751Medicare ID - Type UnspecifiedLOCALITY 099
IL343940OtherLOCALITY 16