Fox Prairie Medical Group P C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036075143 Issued in IL

Legal business name

FOX PRAIRIE MEDICAL GROUP P C

Practice address

2560 Foxfield Rd
Suite 160
St Charles, IL 60174-5797

Phone

(630) 513-8734

NPI assigned

Apr 2, 2007

Organization subpart

No

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

Authorized official

Name

Stasis Kahn, M.D.

Title

Partner

Phone

(630) 513-8734

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289260800000",
    "number": "1093836827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 FOXFIELD RD",
            "address_2": "SUITE 160",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745797",
            "telephone_number": "630-513-8734",
            "fax_number": "630-513-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 FOXFIELD RD",
            "address_2": "SUITE 160",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745797",
            "telephone_number": "630-513-8734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOX PRAIRIE MEDICAL GROUP P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2010-11-09",
        "status": "A",
        "authorized_official_last_name": "KAHN",
        "authorized_official_first_name": "STASIS",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "630-513-8734",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036075143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036064522",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036075143",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036088803",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "04532093",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in St Charles, IL
• Providers in St Charles, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2010; 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.