NPIMap

Organization Active NPI

Zeta Visiting Physician LLC

  • General Practice Physician
  • Batavia, IL
National Provider Identifier
1043042484
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
ZETA VISITING PHYSICIAN LLC
Practice address
2405 Big Woods Dr
Batavia, IL 60510-7650
Phone
(847) 508-9999
Fax
(224) 526-5167
NPI assigned
Aug 15, 2024
Last updated
Aug 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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

Authorized official

Name
Carlo Domingo, NPNPI 1194251272
Title
Managing Partner
Phone
(567) 224-0949

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

2405 Big Woods Dr
Batavia, IL 60510-7650

Mailing address

2405 Big Woods Dr
Batavia, IL 60510-7650
Phone (847) 508-9999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241022001806 IL Part B Supplier - Clinic/Group Practice 7416489943 Receives reassigned benefits from 7 practitioners
Practice locations: Batavia, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1723680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1043042484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2405 BIG WOODS DR",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605107650",
            "telephone_number": "847-508-9999",
            "fax_number": "224-526-5167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 BIG WOODS DR",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605107650",
            "telephone_number": "847-508-9999",
            "fax_number": "224-526-5167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ZETA VISITING PHYSICIAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-15",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "DOMINGO",
        "authorized_official_first_name": "CARLO",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "567-224-0949",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Batavia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.