NPIMap

Organization Active NPI

Rockford Surgical Service, S.C.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Rockford, IL
National Provider Identifier
1073679411
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
ROCKFORD SURGICAL SERVICE, S.C.
Practice address
5668 E State St
Suite1000
Rockford, IL 61108-2490
Phone
(815) 397-7900
Fax
(815) 397-7919
NPI assigned
Dec 29, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Leslie P Edgcomb, M.D.NPI 1629014022
Title
President
Phone
(815) 397-7900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0102X 04200060 IL
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X IL
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X IL
Colon & Rectal Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208C00000X IL
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X IL Primary

Addresses

Primary practice location

5668 E State St
Suite1000
Rockford, IL 61108-2490

Mailing address

5668 E State St
Suite1000
Rockford, IL 61108-2490
Phone (815) 397-7900

Other identifiers 2

IdentifierTypeStateIssuer
10115298OtherILBLUE SHIELD
96719OtherILRAIL ROAD MEDICARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1073679411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5668 E STATE ST",
            "address_2": "SUITE1000",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082490",
            "telephone_number": "815-397-7900",
            "fax_number": "815-397-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5668 E STATE ST",
            "address_2": "SUITE1000",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082490",
            "telephone_number": "815-397-7900",
            "fax_number": "815-397-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKFORD SURGICAL SERVICE, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "EDGCOMB",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-397-7900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Critical Care",
            "state": "IL",
            "license": "04200060",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "10115298",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "96719",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.