North Suburban Family Medicine LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

042-619911 Issued in IL

Legal business name

NORTH SUBURBAN FAMILY MEDICINE LTD

Practice address

150 N River Rd
Suite 310
Des Plaines, IL 60016-1272

Phone

(847) 795-0900

Fax

(847) 795-0955

NPI assigned

Dec 26, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Beth Holly Samuelsohn, D.O.NPI 1184774671

Title

President

Phone

(847) 795-0900

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 5

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

• Beth H Samuelsohn, D.O.

  • Family Medicine Physician
  • Des Plaines, IL
  • NPI 1184774671
  Medicare reassignment Care Compare group NPD Authorized official
• Tina Fruscione Blachut, D.O.

  • Family Medicine Physician
  • Des Plaines, IL
  • NPI 1174785588
  Medicare reassignment Care Compare group NPD
• Carmen Luminita Griza, MD

  • Family Medicine Physician
  • Des Plaines, IL
  • NPI 1861658460
  Medicare reassignment Care Compare group NPD
• Denise Patel, NP

  • Family Nurse Practitioner
  • Des Plaines, IL
  • NPI 1255068060
  Medicare reassignment NPD
• Katherine Washagan, PA-C

  • Medical Physician Assistant
  • Chicago, IL
  • NPI 1174279020
  Medicare reassignment

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

{
    "created_epoch": "1324857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556236800000",
    "number": "1104195809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 CEDAR LN",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600623540",
            "telephone_number": "847-795-0900",
            "fax_number": "847-795-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N RIVER RD",
            "address_2": "SUITE 310",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161272",
            "telephone_number": "847-795-0900",
            "fax_number": "847-795-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SUBURBAN FAMILY MEDICINE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-26",
        "last_updated": "2019-04-26",
        "status": "A",
        "authorized_official_last_name": "SAMUELSOHN",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "HOLLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-795-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "042-619911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Northwest Eye Clinic, LTD.
• Northwest Guidance Center

• Family Medicine Physician in Des Plaines, IL
• Providers in Des Plaines, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2019; 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.