Aspen Medical Group LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

36104917 Issued in IL

Legal business name

ASPEN MEDICAL GROUP LLC

Practice address

1120 Thompson Blvd
Buffalo Grove, IL 60089-1021

Phone

(847) 354-8086

NPI assigned

Feb 1, 2008

Last updated

Feb 2, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexander PoterminNPI 1407842958

Title

Member

Phone

(847) 354-8086

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

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.

• Alexander V. Potermin, M.D.

  • Family Medicine Physician
  • Buffalo Grove, IL
  • NPI 1407842958
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1201824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422835200000",
    "number": "1013195932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 THOMPSON BLVD",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 THOMPSON BLVD",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891021",
            "telephone_number": "847-354-8086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASPEN MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-01",
        "last_updated": "2015-02-02",
        "status": "A",
        "authorized_official_last_name": "POTERMIN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "847-354-8086"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36104917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Buffalo Grove, IL
• Providers in Buffalo Grove, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2015; 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.