Fox Ridge Medical Associates, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036.092485 Issued in IL

Legal business name

FOX RIDGE MEDICAL ASSOCIATES, LLC

Practice address

3633 Municipal Dr
McHenry, IL 60050

Phone

(815) 861-5543

NPI assigned

Jun 25, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Scott Tomlin, MDNPI 1639163850

Title

Practice Owner

Phone

(815) 861-5543

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Tax ID family

Fox Ridge Medical Associates LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fox Ridge Medical Associates, LLC

  • Primary Care Clinic/Center
  • McHenry, IL
  • NPI 1205322716
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey Scott Tomlin, M.D.

  • Internal Medicine Physician
  • McHenry, IL
  • NPI 1639163850
  Medicare reassignment NPD Authorized official
• Kiley C Loch, APRN

  • Internal Medicine Physician
  • McHenry, IL
  • NPI 1487328894
  NPD
• Lauren Mount, NP

  • Family Nurse Practitioner
  • McHenry, IL
  • NPI 1487242830

  Internal Medicine

  NPD
• Lindsey Marie Schlaeg, PA-C

  • Medical Physician Assistant
  • McHenry, IL
  • NPI 1689233488
  NPD
• Kaitlyn M Lukasiewicz, PA-C

  • Physician Assistant
  • Chicago, IL
  • NPI 1144861394

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535414400000",
    "number": "1013402825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3633 MUNICIPAL DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600505434",
            "telephone_number": "779-244-3072",
            "fax_number": "815-331-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3633 MUNICIPAL DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "60050",
            "telephone_number": "815-861-5543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOX RIDGE MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-08-28",
        "status": "A",
        "authorized_official_last_name": "TOMLIN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "815-861-5543",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.092485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "F100494732",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Jean Folk-Jednoroz, PSYD
• Tamara Marie Forman
• Judi Kittle Forner
• Allison Foshee, LCPC
• Gisella Foto
• Fox Ridge Medical Associates, LLC
• Glenda Cordero Fragante, NP-C
• Lisa Franz, LPC
• Rebecca Franzone
• Holly Willahan Fray, M A CCC SLP

• Internal Medicine Physician in McHenry, IL
• Providers in McHenry, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; 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.