Individual provider Active NPI

Lynn G Brown, MD

  • Cardiovascular Disease Physician
  • Kankakee, IL
National Provider Identifier
1013962182
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036082934 Issued in IL
Practice address
500 N Wall St
Kankakee, IL 60901-2942
Phone
(844) 404-4787
Fax
(815) 936-3243
NPI assigned
May 24, 2006
Last updated
Mar 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036082934 IL Primary

Addresses

Primary practice location

500 N Wall St
Kankakee, IL 60901-2942

Mailing address

500 N Wall St
Kankakee, IL 60901-2942
Phone (844) 404-4787

Other identifiers 1

IdentifierTypeStateIssuer
036082934MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lbrown6812@Direct.riversidehealthcare.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040921001086 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Peripheral Vascular Disease 6103894787 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Jan 4, 2018 Accepting new patients
Riverside Health System Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

401 N Wall St
Ste 208
Kankakee, IL 60901
Phone (815) 935-1161

500 N Wall St
Kankakee, IL 60901
Phone (815) 937-9300

500 N Wall St
Ste 100
Kankakee, IL 60901
Phone (815) 933-2557

500 N Wall St
Ste 201
Kankakee, IL 60901
Phone (815) 932-2000

25711 S Egyptian Trl
Monee, IL 60449
Phone (708) 534-7523

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Interoperability endpoints

  • Direct secure messaging: lbrown6812@direct.riversidehealthcare.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1013962182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012942",
            "telephone_number": "844-404-4787",
            "fax_number": "815-936-3243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012942",
            "telephone_number": "844-404-4787",
            "fax_number": "815-936-3243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "LYNN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036082934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036082934",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lbrown6812@Direct.riversidehealthcare.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 N Wall St",
            "city": "Kankakee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609012942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

Verify at the official NPI Registry.