Organization Active NPI

Southwest Nephrology Associates, S.C.

  • Ambulatory Surgical Clinic/Center
  • Orland Park, IL
National Provider Identifier
1104925163
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SOUTHWEST NEPHROLOGY ASSOCIATES, S.C.
Practice address
16605 107TH St
Orland Park, IL 60467-9016
Phone
(708) 226-9860
NPI assigned
Sep 22, 2006
Last updated
Feb 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Authorized official

Name
Ms. Naomi Cassin
Title
Credentialing Manager
Phone
(331) 216-1156

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary
Nephrology Physician 207RN0300X 042618498 IL

Addresses

Primary practice location

16605 107TH St
Orland Park, IL 60467-9016

Mailing address

120 W 22ND St
Ste 200
Oak Brook, IL 60523-1563
Phone (630) 573-5000

Other practice location 1

9125 S Pulaski Rd
Evergreen Park, IL 60805-1441
Phone (708) 422-7715

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@nephdocs.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040825000464 IL Part B Supplier - Clinic/Group Practice 1557335460 Receives reassigned benefits from 16 practitioners
Practice locations: Alsip, IL; Evergreen Park, IL; Orland Park, IL

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0419880Southwest Nephrology Associates SC9125 S Pulaski Rd, Evergreen Park, IL 60805Certificate of waiverAug 31, 2026
14D1030529Southwest Nephrology Associates SC16605 S 107TH Court, Orland Park, IL 60467Certificate of waiverSep 7, 2026

National Provider Directory

National Provider Directory

Locations

12250 S Cicero Ave
Ste 112
Alsip, IL 60803
Phone (708) 371-5308

3650 W 95th St
Evergreen Pk, IL 60805
Phone (708) 422-7715

18210 La Grange Rd
Tinley Park, IL 60487
Phone (708) 342-4411

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770163200000",
    "number": "1104925163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W 22ND ST",
            "address_2": "STE 200",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231563",
            "telephone_number": "630-573-5000",
            "fax_number": "708-422-7816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16605 107TH ST",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604679016",
            "telephone_number": "708-226-9860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9125 S Pulaski Rd",
            "address_purpose": "LOCATION",
            "city": "Evergreen Park",
            "state": "IL",
            "postal_code": "608051441",
            "country_code": "US",
            "telephone_number": "708-422-7715",
            "fax_number": "708-422-7816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHWEST NEPHROLOGY ASSOCIATES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A",
        "authorized_official_last_name": "CASSIN",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "331-216-1156",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "042618498",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@nephdocs.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "120 W 22nd St",
            "city": "Oak Brook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605231557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.