Organization Active NPI

Villa Medical Arts

  • Internal Medicine Physician
  • Villa Park, IL
National Provider Identifier
1124058029
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
VILLA MEDICAL ARTS
Practice address
33 S. Villa Ave.
Suite 2
Villa Park, IL 60181
Phone
(630) 832-9000
Fax
(630) 832-7907
NPI assigned
Jul 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Deepa Fulton
Title
Practice Manager
Phone
(630) 832-9000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

33 S. Villa Ave.
Suite 2
Villa Park, IL 60181

Mailing address

33 S. Villa Ave.
Suite 2
Villa Park, IL 60181
Phone (630) 832-9000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050526000365 IL Part B Supplier - Clinic/Group Practice 9032151329 Receives reassigned benefits from 3 practitioners
Practice locations: Elmhurst, IL; Villa Park, IL; Downers Grove, 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
14D0416770Villa Medical Arts33 S Villa Ave, Ste 2, Villa Park, IL 60181Certificate of waiverMar 13, 2027

National Provider Directory

National Provider Directory

Locations

33 S Villa Ave
Villa Park, IL 60181
Phone (630) 832-9000

33 S Villa Ave
Ste 2
Villa Park, IL 60181
Phone (630) 832-9000

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1124058029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 S. VILLA AVE.",
            "address_2": "SUITE 2",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "60181",
            "telephone_number": "630-832-9000",
            "fax_number": "630-832-7907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 S. VILLA AVE.",
            "address_2": "SUITE 2",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "60181",
            "telephone_number": "630-832-9000",
            "fax_number": "630-832-7907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLA MEDICAL ARTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "FULTON",
        "authorized_official_first_name": "DEEPA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "630-832-9000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.