NPIMap

Organization Active NPI

Swedishamerican Hospital

  • Obstetrics & Gynecology Physician
  • Rockford, IL
National Provider Identifier
1124173851
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
SWEDISHAMERICAN HOSPITAL
Practice address
209 9TH St
Suite 200
Rockford, IL 61104
Phone
(779) 696-2750
NPI assigned
Jan 24, 2007
Last updated
Jul 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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

Authorized official

Name
Don Daniels
Title
VP
Phone
(815) 966-2084

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Obstetrics & Gynecology Physician 207V00000X NU Primary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X NU

Addresses

Primary practice location

209 9TH St
Suite 200
Rockford, IL 61104

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866

Other identifiers 1

IdentifierTypeStateIssuer
14D1002687OtherILCLIA

Other names 1

  • SA Obstetrics and Gynecology Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031215000012 IL Part B Supplier - Clinic/Group Practice 5799698346 Receives reassigned benefits from 506 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Rockford, IL; Roscoe, IL; Belvidere, IL; Rochelle, IL; Freeport, IL; Davis Junction, IL; Byron, IL

National Provider Directory

National Provider Directory

Locations

209 9th St
Rockford, IL 61104
Phone (779) 696-2750

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1124173851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 9TH ST",
            "address_2": "SUITE 200",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61104",
            "telephone_number": "779-696-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWEDISHAMERICAN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "815-966-2084"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D1002687",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SA Obstetrics and Gynecology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SA Obstetrics and Gynecology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; 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.