NPIMap

Organization Active NPI

Aeries Healthcare of Illinois Physician Group

  • Prescribing (Medical) Psychologist
  • Forest Park, IL
National Provider Identifier
1083841076
Registry record updated Jun 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
Legal business name
AERIES HEALTHCARE OF ILLINOIS PHYSICIAN GROUP
Practice address
8311 W Roosevelt Rd
Forest Park, IL 60130
Phone
(708) 209-4150
NPI assigned
Jun 17, 2009
Last updated
Jun 17, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
RIVEREDEGE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2009

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

Authorized official

Name
Mr. Michael Nelson
Title
Cfo
Phone
(708) 209-4156

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prescribing (Medical) Psychologist 103TP0016X IL Primary

Addresses

Primary practice location

8311 W Roosevelt Rd
Forest Park, IL 60130

Mailing address

PO Box 840936
Dallas, TX 72584
Phone (708) 209-4152

National Provider Directory

National Provider Directory
Tax ID family
Riveredge Hospital Inc4 organizations share this tax ID, including this one
Part of
Riveredge Hospital Inc

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245196800000",
    "number": "1083841076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840936",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "72584",
            "telephone_number": "708-209-4152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8311 W ROOSEVELT RD",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "60130",
            "telephone_number": "708-209-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AERIES HEALTHCARE OF ILLINOIS PHYSICIAN GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVEREDEGE HOSPITAL",
        "enumeration_date": "2009-06-17",
        "last_updated": "2009-06-17",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "708-209-4156",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.