NPIMap

Organization Active NPI

Advocate Illinois Masonic Medical Center

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1063688786
Registry record updated May 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125-052303 Issued in IL
Legal business name
ADVOCATE ILLINOIS MASONIC MEDICAL CENTER
Practice address
3048 N Wilton Ave FL 2
Chicago, IL 60657-6710
Phone
(773) 296-5424
Fax
(773) 296-5280
NPI assigned
May 2, 2008
Last updated
May 2, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVOCATE HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 2, 2008

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

Authorized official

Name
Dr. Teresa Ramos, M.D.
Title
Residency Program Director
Phone
(773) 296-7046

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125-052303 IL Primary

Addresses

Primary practice location

3048 N Wilton Ave FL 2
Chicago, IL 60657-6710

Mailing address

836 W Wellington Ave
Chicago, IL 60657-5147

National Provider Directory

National Provider Directory
Tax ID family
Chicago North Surger Ce22 organizations share this tax ID, including this one
Part of
Chicago North Surger Ce

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Interoperability endpoints

  • FHIR API: https://epicproxy.et0301.epichosted.com/FHIRProxyPRD/api/FHIR/R4/

NPI Registry JSON

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209686400000",
    "number": "1063688786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 W WELLINGTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3048 N WILTON AVE FL 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576710",
            "telephone_number": "773-296-5424",
            "fax_number": "773-296-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVOCATE ILLINOIS MASONIC MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVOCATE HEALTHCARE",
        "enumeration_date": "2008-05-02",
        "last_updated": "2008-05-02",
        "status": "A",
        "authorized_official_last_name": "RAMOS",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "RESIDENCY PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "773-296-7046",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125-052303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.