Organization Active NPI

Beth Ledvora M.D. S.C.

  • Psychiatry Physician
  • Palos Heights, IL
National Provider Identifier
1003256462
Registry record updated Jul 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036073475 Issued in IL
Legal business name
BETH LEDVORA M.D. S.C.
Practice address
7350 W College Dr Ste 106
Palos Heights, IL 60463-1188
Phone
(708) 361-5110
Fax
(708) 361-5305
NPI assigned
Jul 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Beth Ledvora, M.D.NPI 1104993161
Title
President
Phone
(708) 361-5110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 036073475 IL Primary

Addresses

Primary practice location

7350 W College Dr Ste 106
Palos Heights, IL 60463-1188

Mailing address

7350 W College Dr Ste 106
Palos Heights, IL 60463-1188
Phone (708) 361-5110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131002000408 IL Part B Supplier - Clinic/Group Practice 4587898754 Receives reassigned benefits from 7 practitioners
Practice locations: Palos Heights, IL

National Provider Directory

National Provider Directory

Locations

7808 W College Dr
Ste 2
Palos Heights, IL 60463
Phone (708) 361-5110

7808 W College Dr
Ste 2W
Palos Heights, IL 60463
Phone (708) 361-5110

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372636800000",
    "number": "1003256462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7350 W COLLEGE DR STE 106",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631188",
            "telephone_number": "708-361-5110",
            "fax_number": "708-361-5305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7350 W COLLEGE DR STE 106",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631188",
            "telephone_number": "708-361-5110",
            "fax_number": "708-361-5305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETH LEDVORA M.D. S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-01",
        "last_updated": "2013-07-01",
        "status": "A",
        "authorized_official_last_name": "LEDVORA",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-361-5110",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036073475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.