RICHARD FELICELDA , NPI 1083095293 — CHICAGO (IL)

NPI 1083095293

4+ Years Experience Individual

RICHARD FELICELDA

06.12.2015
PROVIDER ENUMERATION DATE
06.12.2015
LAST UPDATE DATE
1083095293
NPI NUMBER

About RICHARD FELICELDA

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

RICHARD FELICELDA is a provider established in CHICAGO, IL. The NPI number of RICHARD FELICELDA is 1083095293 and was assigned on 06.12.2015. The practitioners primary taxonomy code is: 246XC2903X .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 606521430
  • Phone: 8473297500
  • Fax: 8478074403
  • Address: 3510 W 79TH ST
  • Address 2: SUITE 4

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1083095293
  • Phone : 8473297500
  • Fax : 8478074403
  • Postalcode : 606521430
  • Address : 3510 W 79TH ST SUITE 4

Provider taxonomy - Specialist/Technologist Cardiovascular

  • Taxonomy code: 246XC2903X

The taxonomy is not the primary taxonomy.

Healthcare provider taxonomy #2 - Radiologic Technologist

  • Taxonomy code: 247100000X

The taxonomy is not the primary taxonomy.

Taxonomy description: An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment.

Contacts:

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  • RICHARD FELICELDA
  • Address : 3510 W 79TH ST SUITE 4
  • Region : CHICAGO, IL
  • NPI : 1083095293
  • Phone : 8473297500
  • Fax : 8478074403
  • Postalcode : 606521430

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address3510 W 79TH ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 4
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code606521430
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number8473297500
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number8478074403
The fax number associated with the location address of the provider being identified.
NPI1083095293
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1246XC2903X
Provider Enumeration Date06.12.2015
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated06.12.2015
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)RICHARD FELICELDA
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address3510 W 79TH ST
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE 4
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code606521430
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number8473297500
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number8478074403
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1246XC2903X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Specialist/Technologist Cardiovascular
Healthcare Provider Primary Taxonomy Switch 1N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2247100000X
Healthcare Provider Taxonomy 2Radiologic Technologist
An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment.
Healthcare Provider Primary Taxonomy Switch 2N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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