NPIMap

Organization Active NPI

Swedishamerican Hospital

  • Family Medicine Physician
  • Rockford, IL
National Provider Identifier
1093827115
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SWEDISHAMERICAN HOSPITAL
Practice address
2404 Charles St
Rockford, IL 61108
Phone
(779) 696-7910
NPI assigned
Aug 31, 2006
Last updated
Jul 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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

Authorized official

Name
Don Daniels
Title
VP
Phone
(815) 966-2084

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2404 Charles St
Rockford, IL 61108

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866

Other identifiers 2

IdentifierTypeStateIssuer
14D0430291OtherILCLIA
016OtherILTRICARE SUFFIX #

Other names 1

  • SA Five Points Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031215000012 IL Part B Supplier - Clinic/Group Practice 5799698346 Receives reassigned benefits from 506 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Rockford, IL; Roscoe, IL; Belvidere, IL; Rochelle, IL; Freeport, IL; Davis Junction, IL; Byron, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1093827115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 CHARLES ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61108",
            "telephone_number": "779-696-7910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWEDISHAMERICAN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "815-966-2084"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D0430291",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE SUFFIX #",
            "identifier": "016",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SA Five Points Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SA Five Points Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.