Wheaton Orthopaedics, LTD.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041162131 Issued in IL

Legal business name

WHEATON ORTHOPAEDICS, LTD.

Doing business as

SportsMed Wheaton Orthopaedics

Practice address

327 Gundersen Dr
Suite a
Carol Stream, IL 60188-2402

Phone

(630) 665-9155

Fax

(630) 665-5557

NPI assigned

Nov 25, 2008

Last updated

Nov 25, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

WHEATON ORTHOPAEDICS, LTDAs reported in NPPES

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

Authorized official

Name

Mrs. Mamie T Martin

Title

Business Office Manager

Phone

(630) 784-3295

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• SportsMed Wheaton Orthopaedics Doing business as

Part of

Sportsmed Wheaton Ortho

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Wheaton Orthopaedics, LTD.

  • Specialist
  • Carol Stream, IL
  • NPI 1215938170
  NPPES parent name

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.

• Andrea Lynn Modica, RN

  • Registered Nurse
  • Carol Stream, IL
  • NPI 1356669022
  NPD (past)

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

{
    "created_epoch": "1227571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227571200000",
    "number": "1033364534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 GUNDERSEN DR",
            "address_2": "SUITE A",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882402",
            "telephone_number": "630-665-9155",
            "fax_number": "630-665-5557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 GUNDERSEN DR",
            "address_2": "SUITE A",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882402",
            "telephone_number": "630-665-9155",
            "fax_number": "630-665-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHEATON ORTHOPAEDICS, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHEATON ORTHOPAEDICS, LTD",
        "enumeration_date": "2008-11-25",
        "last_updated": "2008-11-25",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "MAMIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "630-784-3295",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041162131",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041261134",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF ILLINOIS",
            "identifier": "02233497",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SportsMed Wheaton Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Tammy M White, PT
• Whole Lotus Therapy, PLLC
• Marc L Wiener, M.D.

• Registered Nurse in Carol Stream, IL
• Providers in Carol Stream, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; 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.