Presbyterian Homes

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PRESBYTERIAN HOMES

Practice address

1100 Pembridge Drive
Lake Forest, IL 60045

Phone

(847) 604-6700

Fax

(847) 570-3426

NPI assigned

Mar 27, 2006

Organization subpart

No

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

Authorized official

Name

Robert E Landsman

Title

Vice President of Finance

Phone

(847) 492-4859

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Lake Forest Place Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Westminster Place

  • Multi-Specialty Clinic/Center
  • Evanston, IL
  • NPI 1033179411

  O20050110000981

  Same enrollment

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212537600000",
    "number": "1063472520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 GRANT STREET",
            "address_2": "ATTN ACCOUNTING DEPARTMENT",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "847-492-4871",
            "fax_number": "847-570-3426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 PEMBRIDGE DRIVE",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "60045",
            "telephone_number": "847-604-6700",
            "fax_number": "847-570-3426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOMES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2008-06-04",
        "status": "A",
        "authorized_official_last_name": "LANDSMAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "847-492-4859"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ILLINOIS",
            "identifier": "04932281",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Forest Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deepa Nonesupplied Popuri, MD
• Caitlin Griffin Porter, PA-C
• Marc Posner, M.D.
• Posture Palooza
• Ramanujam Govindarajan Prativadi, MD
• Presbyterian Homes
• Adam E Prescott, MD
• Michael Lee Primack, D.D.S.
• Bernard B Pritzker, M.D.
• Amalia Maria Prodanovic

• Multi-Specialty Clinic/Center in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Multi-Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2008; 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.