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PROVIDA FAMILY MEDICINE
NPI 1881890333
Family Medicine in Gurnee, IL

Active since June 22, 2007CLIA 14D0669448 · Waiver
1425 N HUNT CLUB RD STE 100, GURNEE, IL 60031(847) 548-2200(847) 548-2865 Get Directions Write a Review

NPPES record last updated: January 31, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Provida Family Medicine NPPES

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

PROVIDA FAMILY MEDICINE (NPI 1881890333) is a healthcare organization registered as a family medicine in Gurnee, Illinois and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through September 26, 2027 and lists Luis I Salazar, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1881890333
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePROVIDA HEALTH CENTER SC
Location Address1425 N HUNT CLUB RD STE 100Gurnee, IL 60031
Mailing Address1425 N Hunt Club Rd Ste 100Gurnee, IL 60031-2632 · (847) 548-2200 · Fax (847) 548-2865
Phone(847) 548-2200
Fax(847) 548-2865
Organization SubpartNo
Authorized OfficialLuis I SalazarAuthorized Official · (847) 548-2200
Enumeration DateJune 22, 2007
Last NPPES UpdateJanuary 31, 2024
NPPES CertifiedJanuary 31, 2024
✔ NPI 1881890333 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IL · 042616958
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.
1425 N HUNT CLUB RD STE 100, Gurnee, IL 60031
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Other Names 1

Doing Business AsProvida Family Medicine

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0669448

Provida Health Center Sc · Gurnee, IL
Active · expires Sep 26, 2027
CLIA Number14D0669448
Laboratory TypePhysician Office
Certificate Effective DateSeptember 27, 2025
Certificate Expiration DateSeptember 26, 2027
Laboratory DirectorLuis I. Salazar MD
Laboratory Phone(847) 548-2200
Laboratory LocationProvida Health Center Sc1425 Hunt Club Road Ste 100, Gurnee, IL 60031
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MEGAN GREGORY KAHUE PA-C
Physician Assistant (Medical)
1425 N HUNT CLUB RD STE 100
GURNEE, IL 60031
Lake County (847) 548-2200
SUSIE ANNETTE GONZALEZ-LAZAREVIC APRN
Nurse Practitioner (Family)
1425 N HUNT CLUB RD STE 100
GURNEE, IL 60031
Lake County (847) 548-2200
DR. LUIS I SALAZAR M.D.
Family Medicine
1425 N HUNT CLUB RD STE 100
GURNEE, IL 60031
Lake County (847) 548-2200
MS. JESSIE L. DINELLI NP
Nurse Practitioner (Family)
1425 N HUNT CLUB RD STE 100
GURNEE, IL 60031
Lake County (847) 548-2200
KELLY JEAN PURCELL PA-C
Physician Assistant
1425 N HUNT CLUB RD STE 100
GURNEE, IL 60031
Lake County (847) 548-2200
DOMINIC ALESANDRINI PA-C
Physician Assistant
1425 N HUNT CLUB RD STE 100
GURNEE, IL 60031
Lake County (847) 548-2200
ALEJANDRA CAMACHO FNP-C
Nurse Practitioner (Family)
1425 N HUNT CLUB RD STE 100
GURNEE, IL 60031
Lake County (847) 548-2200
KSENIA SAMVEL PA-C
Physician Assistant
1425 N HUNT CLUB RD STE 100
GURNEE, IL 60031
Lake County (847) 548-2200

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 Provida Health Center Sc's NPI number?

The NPI number for Provida Health Center Sc is 1881890333. It was assigned to this organization in the NPPES registry on June 22, 2007. The provider is doing business as Provida Family Medicine.

Where is Provida Health Center Sc located?

Provida Health Center Sc is located at 1425 N Hunt Club Rd Ste 100, Gurnee, IL 60031. The listed phone number is (847) 548-2200.

What is Provida Health Center Sc's specialty?

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

Does Provida Health Center Sc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D0669448) is associated with this NPI, valid through September 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Provida Health Center Sc was last updated on January 31, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.