Organization Active NPI

Cyber Medical Group LLC

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1093208449
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CYBER MEDICAL GROUP LLC
Practice address
5067 N Lincoln Ave Apt 201
Chicago, IL 60625-8188
Phone
(414) 215-4419
NPI assigned
Jun 11, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Authorized official

Name
Igor Prus
Title
President
Phone
(414) 215-4419

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

5067 N Lincoln Ave Apt 201
Chicago, IL 60625-8188

Mailing address

5067 N Lincoln Ave Apt 201
Chicago, IL 60625-8188

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1093208449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5067 N LINCOLN AVE APT 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606258188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5067 N LINCOLN AVE APT 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606258188",
            "telephone_number": "414-215-4419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CYBER MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-11",
        "last_updated": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "PRUS",
        "authorized_official_first_name": "IGOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-215-4419"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; 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.