CRESTWOOD ASSOCIATED MEDICAL CENTER LTD
NPI 1104341163
Family Medicine in Crestwood, IL

Q: What is Crestwood Associated Medical Center Ltd's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since August 10, 2017

13705 CICERO AVE, CRESTWOOD, IL 60418(708) 385-4416(708) 388-8825 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 21, 2022, Aug 10, 2017 (2 updates tracked since 2017).

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About Crestwood Associated Medical Center Ltd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CRESTWOOD ASSOCIATED MEDICAL CENTER LTD (NPI 1104341163) is a healthcare organization registered as a family medicine in Crestwood, Illinois and active in the NPI registry since August 2017. The organization lists John William Revello, President, as its authorized official.

NPPES Registry Identity

NPI1104341163

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameCRESTWOOD ASSOCIATED MEDICAL CENTER LTD

Location Address13705 CICERO AVECrestwood, IL 60418-1824

Mailing Address13705 S. Cicero Ave.Crestwood, IL 60445 · (708) 385-4416 · Fax (708) 388-8825

Phone(708) 385-4416

Fax(708) 388-8825

Organization SubpartNo

Authorized OfficialJohn William RevelloPresident · (708) 385-4416

Enumeration DateAugust 10, 2017

Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration

✔ NPI 1104341163 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in IL · 036.103914

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedChiropractorTaxonomy 111N00000X · License 038010310 (IL)

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X · License 036039801 (IL)

Also ListedClinic/Center · Physical TherapyTaxonomy 261QP2000X · License 070.005243 (IL)

13705 CICERO AVE, Crestwood, IL 60418

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Crestwood Associated Medical Center Ltd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 3 clinicians reassign Medicare billing to Crestwood Associated Medical Center Ltd, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

John Revello, D.C.

Chiropractic

NPI 1710928056

14406 JOHN HUMPHREY DRIVE
Orland Park, IL 60462

(708) 364-0638

5.9 mi

Vincent Tupper, M.D.

Interventional Pain Management

NPI 1609139583

3000 N HALSTED ST STE 823
Chicago, IL 60657

(773) 296-7937

✔ PECOS✔ Accepts Medicare21 mi

Krishna Parameswar, M.D.

Physical Medicine and Rehabilitation

NPI 1780620690

2355 ROYAL BLVD
Elgin, IL 60123

(872) 231-3162

✔ PECOS42 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Crestwood Associated Medical Center Ltd's NPI number?

The NPI number for Crestwood Associated Medical Center Ltd is 1104341163. It was assigned to this organization in the NPPES registry on August 10, 2017.

Where is Crestwood Associated Medical Center Ltd located?

Crestwood Associated Medical Center Ltd is located at 13705 Cicero Ave, Crestwood, IL 60418. The listed phone number is (708) 385-4416.

What is Crestwood Associated Medical Center Ltd's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Crestwood Associated Medical Center Ltd enrolled in Medicare?

Yes. Crestwood Associated Medical Center Ltd is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Crestwood Associated Medical Center Ltd?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Crestwood Associated Medical Center Ltd, in Chiropractic, Interventional Pain Management and Physical Medicine and Rehabilitation. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Crestwood Associated Medical Center Ltd was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.