NPIMap

Organization Active NPI

Sunshine Pediatrics, S.C.

  • Pediatrics Physician
  • Ingleside, IL
National Provider Identifier
1053417741
Registry record updated Feb 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036108990 Issued in IL
Legal business name
SUNSHINE PEDIATRICS, S.C.
Practice address
214 Washington St
Ste 3
Ingleside, IL 60041-9208
Phone
(847) 587-9090
Fax
(847) 587-9093
NPI assigned
Sep 16, 2006
Last updated
Feb 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2010

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

Authorized official

Name
William Utley, M.D.
Title
President
Phone
(847) 587-9090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036108990 IL Primary

Addresses

Primary practice location

214 Washington St
Ste 3
Ingleside, IL 60041-9208

Mailing address

214 Washington St
Ste 3
Ingleside, IL 60041-9208
Phone (847) 587-9090

Other identifiers 1

IdentifierTypeStateIssuer
4932453OtherILBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266364800000",
    "number": "1053417741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 WASHINGTON ST",
            "address_2": "STE 3",
            "city": "INGLESIDE",
            "state": "IL",
            "postal_code": "600419208",
            "telephone_number": "847-587-9090",
            "fax_number": "847-587-9093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 WASHINGTON ST",
            "address_2": "STE 3",
            "city": "INGLESIDE",
            "state": "IL",
            "postal_code": "600419208",
            "telephone_number": "847-587-9090",
            "fax_number": "847-587-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSHINE PEDIATRICS, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2010-02-17",
        "status": "A",
        "authorized_official_last_name": "UTLEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-587-9090",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036108990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4932453",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ingleside, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; 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.