Crestwood Associated Medical Center Ltd
NPI 1104341163ActiveOrganization· Family Medicine· Crestwood, IL
Family Medicine in Crestwood, Illinois, registered in NPPES in August 2017. The authorized official on file is John William Revello, D.C., President. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1104341163 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 10, 2017 |
| Last updated in NPPES | Jul 21, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | 036.103914 | IL |
| Chiropractor | 111N00000X | 038010310 | IL |
| Orthopaedic Surgery | 207X00000X | 036039801 | IL |
| Clinic/Center, Physical Therapy | 261QP2000X | 070.005243 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL) |
|---|
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