NPIMap

Organization Active NPI

West Suburban Medical Center

Doing business as Berwyn Clinic

  • Internal Medicine Physician
  • Berwyn, IL
National Provider Identifier
1073742748
Registry record updated Jul 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WEST SUBURBAN MEDICAL CENTER
Doing business as
Berwyn Clinic
Practice address
3245 S. Grove Avenue
Ste 105 & 106
Berwyn, IL 60402
Phone
(708) 795-0383
Fax
(708) 484-9545
NPI assigned
Jul 2, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2009

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

Authorized official

Name
Susan Pfioter
Title
System Director
Phone
(847) 813-3716

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary
Cardiovascular Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RC0000X

Addresses

Primary practice location

3245 S. Grove Avenue
Ste 105 & 106
Berwyn, IL 60402

Mailing address

35001 Eagle Way
Chicago, IL 60678-1522

Other identifiers 1

IdentifierTypeStateIssuer
1620469OtherILBCBS GRP

Other names 1

  • Berwyn Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
West Suburban Hospital6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

3245 Grove Ave
Ste 105
Berwyn, IL 60402
Phone (708) 484-9775

NPI Registry JSON

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

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246492800000",
    "number": "1073742748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35001 EAGLE WAY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606781522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3245 S. GROVE AVENUE",
            "address_2": "STE 105 & 106",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "60402",
            "telephone_number": "708-795-0383",
            "fax_number": "708-484-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SUBURBAN MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-02",
        "last_updated": "2009-07-02",
        "status": "A",
        "authorized_official_last_name": "PFIOTER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR",
        "authorized_official_telephone_number": "847-813-3716"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GRP",
            "identifier": "1620469",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berwyn Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berwyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2009; 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.