NPIMap

Organization Active NPI

River Forest Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • River Forest, IL
National Provider Identifier
1083615470
Registry record updated Mar 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
7002561 Issued in IL
Legal business name
RIVER FOREST SURGERY CENTER LLC
Practice address
7427 Lake St
River Forest, IL 60305-1817
Phone
(708) 488-1200
Fax
(708) 771-7321
NPI assigned
Aug 9, 2005
Last updated
Mar 30, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2018

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

Authorized official

Name
Lisa Gill
Title
Administrator
Phone
(708) 771-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 7002561 IL Primary

Addresses

Primary practice location

7427 Lake St
River Forest, IL 60305-1817

Mailing address

7427 Lake St
River Forest, IL 60305-1817
Phone (708) 488-1200

Other identifiers 1

IdentifierTypeStateIssuer
490005430OtherRR MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050629000713 IL Part B Supplier - Ambulatory Surgical Center 6800885492 Practice locations: River Forest, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Novamed Surgery Center of River Forest LLCCCN 14C0001023
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
River Forest Surgery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522368000000",
    "number": "1083615470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7427 LAKE ST",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051817",
            "telephone_number": "708-488-1200",
            "fax_number": "708-771-0841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7427 LAKE ST",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051817",
            "telephone_number": "708-488-1200",
            "fax_number": "708-771-7321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER FOREST SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2018-03-30",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "708-771-3334"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7002561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "490005430",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in River Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.