NPIMap

Organization Active NPI

Northeast Radiology Associates, S.C.

  • Radiology Clinic/Center
  • Lake Forest, IL
National Provider Identifier
1033206271
Registry record updated Oct 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
NORTHEAST RADIOLOGY ASSOCIATES, S.C.
Practice address
660 N Westmoreland Rd
Radiology Department
Lake Forest, IL 60045-1659
Phone
(847) 535-6313
NPI assigned
Oct 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2007

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

Authorized official

Name
Dr. Ronald Debruin, M.D.
Title
Preseident
Phone
(847) 535-6313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

660 N Westmoreland Rd
Radiology Department
Lake Forest, IL 60045-1659

Mailing address

660 N Westmoreland Rd
Radiology Department
Lake Forest, IL 60045-1659
Phone (847) 535-6313

Other identifiers 2

IdentifierTypeStateIssuer
4923631OtherILBCBS ID
CH1744OtherRAILROAD ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193356800000",
    "number": "1033206271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 N WESTMORELAND RD",
            "address_2": "RADIOLOGY DEPARTMENT",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451659",
            "telephone_number": "847-535-6313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 N WESTMORELAND RD",
            "address_2": "RADIOLOGY DEPARTMENT",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451659",
            "telephone_number": "847-535-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST RADIOLOGY ASSOCIATES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2007-10-26",
        "status": "A",
        "authorized_official_last_name": "DEBRUIN",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "PRESEIDENT",
        "authorized_official_telephone_number": "847-535-6313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID",
            "identifier": "4923631",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD ID",
            "identifier": "CH1744",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.