NPIMap

Organization Active NPI

Cep America Illinois LLP

  • Emergency Medicine Physician
  • Shiloh, IL
National Provider Identifier
1134587637
Registry record updated Jan 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
CEP AMERICA ILLINOIS LLP
Practice address
1404 Cross St
Shiloh, IL 62269-2988
Phone
(618) 233-7750
NPI assigned
Jan 29, 2016
Last updated
Jan 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2016

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

Authorized official

Name
Theophile Koury, MD
Title
Administrative VP of Operations
Phone
(510) 350-2680

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

1404 Cross St
Shiloh, IL 62269-2988

Mailing address

2100 Powell St Ste 900
Emeryville, CA 94608-1844
Phone (510) 350-2680

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120322000587 IL Part B Supplier - Clinic/Group Practice 3274793633 Receives reassigned benefits from 1,241 practitioners
35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elk Grove Village, IL; Evanston, IL; Greenville, IL; Highland, IL; Hoffman Estates, IL; Joliet, IL; Kankakee, IL; Libertyville, IL…

Other NPIs on the same Medicare enrollment 35

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

View all 35

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1454025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454025600000",
    "number": "1134587637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL ST STE 900",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081844",
            "telephone_number": "510-350-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 CROSS ST",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622692988",
            "telephone_number": "618-233-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEP AMERICA ILLINOIS LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-29",
        "last_updated": "2016-01-29",
        "status": "A",
        "authorized_official_last_name": "KOURY",
        "authorized_official_first_name": "THEOPHILE",
        "authorized_official_title_or_position": "ADMINISTRATIVE VP OF OPERATIONS",
        "authorized_official_telephone_number": "510-350-2680",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shiloh, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.