Bonaventure Medical Foundation

Key facts

NPI

1083960108

Entity type

Organization (NPI type 2)

Primary specialty

Medical Specialty Clinic/Center 261QM2500X

License

164005616 (IL)

Legal business name

BONAVENTURE MEDICAL FOUNDATION

Practice address

864 W Stearns Rd
Suite 106
Bartlett, IL 60103-4800

Phone

(847) 252-6098

NPI assigned

Jul 26, 2012

Organization subpart

No

Authorized official

Name

Margaret Rose Connor, R.D., L.D.N.

Title

Reg. Dietitian/Program Coordinator

Phone

(847) 252-6098

Corporate family (same tax ID) 1

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

• Bonaventure Medical Foundation, LLC Health Educator · Schaumburg, IL · NPI 1336806736
  NPD tax ID

National Provider Directory

Tax ID family

Bonaventure Medical LLC (2 organizations share this tax ID)

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/380/brand/1/csg/1/fhir/r4

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 26, 2012.

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343260800000",
    "number": "1083960108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "864 W STEARNS RD",
            "address_2": "SUITE 106",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601034800",
            "telephone_number": "847-252-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "864 W STEARNS RD",
            "address_2": "SUITE 106",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601034800",
            "telephone_number": "847-252-6098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONAVENTURE MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-26",
        "last_updated": "2012-07-26",
        "status": "A",
        "authorized_official_last_name": "CONNOR",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "REG. DIETITIAN/PROGRAM COORDINATOR",
        "authorized_official_telephone_number": "847-252-6098",
        "authorized_official_credential": "R.D., L.D.N."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IL",
            "license": "164005616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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