NPIMap

Organization Active NPI

Specialty Physicians of Illinois, LLC

  • Internal Medicine Physician
  • Greenwood, IN
National Provider Identifier
1124075676
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 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
Last updated
Feb 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

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

Authorized official

Name
Donna Phalen
Title
Director
Phone
(219) 554-4548

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X
Dermatology Physician 207N00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary
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 1

IdentifierTypeStateIssuer
203979OtherILMEDICARE PTAN

Other names 1

  • WellGroup Health Partners, LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

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 of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

30 E 15th St
Ste 207
Chicago Heights, IL 60411
Phone (708) 679-2600

3649 W 183rd St
Ste 104
Hazel Crest, IL 60429
Phone (708) 960-2294

18408 Governors Hwy
Homewood, IL 60430
Phone (708) 647-0571

20939 S Cicero Ave
Matteson, IL 60443
Phone (708) 679-2770

1938 E Lincoln Hwy
Ste 210
New Lenox, IL 60451

20201 Crawford Ave
Ste 1276
Olympia Fields, IL 60461
Phone (708) 679-2270

3700 W 203rd St
Ste 200
Olympia Fields, IL 60461
Phone (708) 679-2013

3800 W 203rd St
Olympia Fields, IL 60461
Phone (708) 747-0461

2480 E Sauk Trl
Sauk Village, IL 60411
Phone (708) 758-4800

3707 Doty Rd
Ste F
Woodstock, IL 60098

Practitioners & affiliated clinicians

Practitioners 182

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 182

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676419200000",
    "number": "1124075676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 SIERRA DR STE 400",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461437241",
            "telephone_number": "317-528-4291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3700 W 203rd St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Olympia Fields",
            "state": "IL",
            "postal_code": "604611180",
            "country_code": "US",
            "telephone_number": "708-679-2013",
            "fax_number": "708-503-3295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECIALTY PHYSICIANS OF ILLINOIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A",
        "authorized_official_last_name": "PHALEN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "219-554-4548"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "203979",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellGroup Health Partners, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "WellGroup Health Partners, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Greenwood, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; 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.