NPIMap

Organization Active NPI

Foroutan & Associates SC

  • Psychiatry Physician
  • Sycamore, IL
National Provider Identifier
1063445476
Registry record updated May 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036110360 Issued in IL
Legal business name
FOROUTAN & ASSOCIATES SC
Practice address
2111 Midlands CT
Suite 202
Sycamore, IL 60178-3125
Phone
(630) 222-5574
NPI assigned
Jul 9, 2006
Last updated
May 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2015

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

Authorized official

Name
Mardjan Foroutan, MDNPI 1619900024
Title
Owner
Phone
(630) 222-5574

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
Psychiatry Physician 2084P0800X 036110360 IL Primary

Addresses

Primary practice location

2111 Midlands CT
Suite 202
Sycamore, IL 60178-3125

Mailing address

920 W Prairie Dr Ste I
Sycamore, IL 60178-3123
Phone (708) 532-6029

Other identifiers 1

IdentifierTypeStateIssuer
0001932083OtherILBCBS PROVIDER #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061004000316 IL Part B Supplier - Clinic/Group Practice 4688670284 Receives reassigned benefits from 2 practitioners
Practice locations: Dekalb, IL; Sandwich, IL; Sycamore, IL

National Provider Directory

National Provider Directory

Locations

2111 Midlands Ct
Ste 202
Sycamore, IL 60178
Phone (630) 222-5574

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432166400000",
    "number": "1063445476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 W PRAIRIE DR STE I",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783123",
            "telephone_number": "708-532-6029",
            "fax_number": "708-532-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 MIDLANDS CT",
            "address_2": "SUITE 202",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783125",
            "telephone_number": "630-222-5574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOROUTAN & ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2015-05-21",
        "status": "A",
        "authorized_official_last_name": "FOROUTAN",
        "authorized_official_first_name": "MARDJAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-222-5574",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036110360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "0001932083",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sycamore, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; 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.