Specialty Physicians of Illinois, LLC
Organization Active NPI Internal Medicine Physician · Greenwood, IN
NPI 1124075676 · NPPES record last updated Feb 15, 2023
Key facts
- NPI
- 1124075676
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- SPECIALTY PHYSICIANS OF ILLINOIS, LLC
- Practice address
- 1040 Sierra Dr Ste 400
Greenwood, IN 46143-7241 - Phone
- (317) 528-4291
- NPI assigned
- May 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Donna Phalen
- Title
- Director
- Phone
- (219) 554-4548
Other NPIs on the same Medicare enrollment 1
Member of 1
Practitioners 182
-
Mark Allen Grevious, M.D.
-
Hilton M Hudson II, M.D.
-
Marco N. Khiella, MD
-
Heidi A King, RD
-
Judi Ann Knowles Miller, M.D.
-
Amit Kumar, M.D.
-
Ann M Waldron, APN
-
Tushar Advani, MD, PHD
-
Sufyan Ahmad, DO
-
Vasia A Ahmed, M.D.
-
Zohair Ahmed, M.D.
-
Elke Aippersbach, M.D.,M.SC.,
-
Tara Allen, MS, RDN, LDN
-
Vinod N Alluri, M.D.
-
Amer Alsamman, MD
-
Dexter Edwin Arrington, M.D.
-
Marie Michele Baird, D.O.
-
Lubomyr Boris, D.O.
-
Joi F Bradshaw, MD
-
Larina Branch, DNP-FNP-BC
-
Gerald Cahill, M.D.
-
Bridgette Millicent Cartwright Arnett, M.D., PHD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031201000602 | IL | Part B Supplier - Clinic/Group Practice | 4183529456 |
Receives reassigned benefits from 155 practitioners 1 other NPI on this enrollment Practice locations: Park Forest, IL; Tinley Park, IL; Richton Park, IL; Olympia Fields, IL; Oak Lawn, IL; Homewood, IL; Hazel Crest, IL; Frankfort, IL… |
National Provider Directory
Locations
30 E 15th St
Ste 202
Chicago Heights, IL 60411
Phone (708) 754-7777
30 E 15th St
Ste 207
Chicago Heights, IL 60411
Phone (708) 679-2600
3235 Vollmer Rd
Ste 147
Flossmoor, IL 60422
Phone (708) 799-2333
3611 W 183rd St
Hazel Crest, IL 60429
Phone (708) 799-5900
3649 W 183rd St
Ste 104
Hazel Crest, IL 60429
Phone (708) 960-2294
19665 S La Grange Rd
Mokena, IL 60448
Phone (708) 479-9888
1938 E Lincoln Hwy
Ste 210
New Lenox, IL 60451
3700 W 203rd St
Ste 111
Olympia Fields, IL 60461
Phone (708) 679-2512
20201 Crawford Ave
Ste 1276
Olympia Fields, IL 60461
Phone (708) 679-2270
20201 Crawford Ave
Ste 1400
Olympia Fields, IL 60461
Phone (708) 379-2310
3700 W 203rd St
Ste 204
Olympia Fields, IL 60461
Phone (708) 679-2560
3700 W 203rd St
Ste 200
Olympia Fields, IL 60461
Phone (708) 679-2013
3700 W 203rd St
Ste 215
Olympia Flds, IL 60461
Phone (708) 747-1700
3800 W 203rd St
Ste 209
Olympia Flds, IL 60461
Phone (708) 283-1800
20121 Crawford Ave
Olympia Flds, IL 60461
Phone (219) 922-3040
2480 E Sauk Trl
Sauk Village, IL 60411
Phone (708) 758-4800
3707 Doty Rd
Ste F
Woodstock, IL 60098
1040 Sierra Dr
Greenwood, IN 46143
Phone (317) 528-2759
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician |
207K00000X | |||
| Dermatology Physician |
207N00000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| Nuclear Medicine Physician |
207U00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Ophthalmology Physician |
207W00000X | |||
| Orthopaedic Surgery Physician |
207X00000X | |||
| Otolaryngology Physician |
207Y00000X | |||
| Pediatrics Physician |
208000000X | |||
| Neurology Physician |
2084N0400X | |||
| Diagnostic Radiology Physician |
2085R0202X | |||
| Diagnostic Ultrasound Physician |
2085U0001X | |||
| Surgery Physician |
208600000X | |||
| Urology Physician |
208800000X |
Addresses
Primary practice location
1040 Sierra Dr Ste 400
Greenwood, IN 46143-7241
Mailing address
PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800
Other practice location 1
3700 W 203rd St
Suite 200
Olympia Fields, IL 60461-1180
Phone (708) 679-2013
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203979 | Other | IL | MEDICARE PTAN |
Other names
- WellGroup Health Partners, LLC
Other providers in Greenwood, IN
- Lauren Spainhower
- Julie Christine Spalding
- Ashley N Sparks
- Madison Sparrow
- Brooklynn Starr Spears-Voss
- Amy Denise Spencer
- Erin Marie Spencer
- Spine-Tek Neuromonitoring, Inc
- Deborah A Spista
- Emily Nicole Spista
All providers in Greenwood, IN · Internal Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.