Doreena M McBride MD PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

DOREENA M MCBRIDE MD PC

Doing business as

PEDICLINIC

Practice address

461 Brown Blvd
Bourbonnais, IL 60914-2322

Phone

(815) 933-5700

Fax

(815) 933-8011

NPI assigned

Jul 6, 2006

Organization subpart

No

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

Authorized official

Name

Doreena McBride, MDNPI 1801830799

Title

President

Phone

(815) 933-5700

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• PEDICLINIC Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Doreena M McBride, MD

  • Pediatrics Physician
  • Bourbonnais, IL
  • NPI 1801830799
  NPD (past) Authorized official

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1093747636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 BROWN BLVD",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142322",
            "telephone_number": "815-933-5700",
            "fax_number": "815-933-8011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 BROWN BLVD",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142322",
            "telephone_number": "815-933-5700",
            "fax_number": "815-933-8011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOREENA M MCBRIDE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "MCBRIDE",
        "authorized_official_first_name": "DOREENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-933-5700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D0918525",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4604555",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDICLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jon E Dodds, LCPC
• Erin Nicole Doherty, LCSW
• Erin Margaret Domzalski, DT
• Timothy E Donnelly, PT
• Jaden Doran
• Courtney Doyle
• Dr. Katie Maier DC, LTD
• Dr.Vasanwala LLC
• DRS. Slaby, Adams and Tietjens, LTD.
• Brent Patrick Dunlap, O.D.

• Pediatrics Physician in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.