NPIMap

Organization Active NPI

Adventist Midwest Health

  • Family Medicine Physician
  • La Grange, IL
National Provider Identifier
1104953280
Registry record updated Apr 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ADVENTIST MIDWEST HEALTH
Practice address
5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone
(708) 245-8900
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2016

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

Authorized official

Name
Mrs. Ruby Mann
Title
Director of Managed Care
Phone
(630) 856-6884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5101 Willow Springs Rd
La Grange, IL 60525-2600

Mailing address

5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone (708) 245-8900

Other identifiers 1

IdentifierTypeStateIssuer
1615787OtherBCBS

Other names 1

  • ADVENTIST LAGRANGE FAMILY MEDICINE CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040427000900 IL Part B Supplier - Clinic/Group Practice 8224025887 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Grange, IL; Westchester, IL; Lagrange, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

3739 Grand Blvd
Brookfield, IL 60513
Phone (608) 438-9468

5201 Willow Springs Rd
Ste 200
La Grange Highlands, IL 60525
Phone (708) 245-7490

606 W Burlington Ave
Lagrange Hlds, IL 60525
Phone (708) 352-2250

1919 Midwest Rd
Oak Brook, IL 60523

619 Plainfield Rd
Ste 200
Willowbrook, IL 60527
Phone (708) 245-9000

Practitioners & affiliated clinicians

Practitioners 50

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

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1104953280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 WILLOW SPRINGS RD",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252600",
            "telephone_number": "708-245-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 WILLOW SPRINGS RD",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252600",
            "telephone_number": "708-245-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST MIDWEST HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "RUBY",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "630-856-6884",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1615787",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVENTIST LAGRANGE FAMILY MEDICINE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Grange, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; 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.