Primesource Healthcare Systems, Inc.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

016.003027 Issued in IL

Legal business name

PRIMESOURCE HEALTHCARE SYSTEMS, INC.

Practice address

2100 E Lake Cook Rd
Suite 1100
Buffalo Grove, IL 60089-1999

Phone

(800) 317-0711

Fax

(877) 821-6402

NPI assigned

Jan 13, 2015

Last updated

Jan 13, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Fleming

Title

Ceo/President

Phone

(800) 317-0711

Specialties & licenses 4

Addresses

Locations (25 of 40)

Practitioners 13

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.

• David M Choi, MD

  • Cornea and External Diseases Specialist Physician
  • Riverside, CA
  • NPI 1912981598
  NPD (past)
• Yetta Christian

  • Administrator Registered Nurse
  • Ellettsville, IN
  • NPI 1275415572
  NPD (past)
• Kayla Davis, OTR

  • Occupational Therapist
  • Greenwood, IN
  • NPI 1093085136
  NPD (past)
• Joseph Fenton Faust, M.D.

  • Ophthalmology Physician
  • Zephyrhills, FL
  • NPI 1376762047
  NPD (past)
• Sarah Lock, BS, MS, PT, DPT

  • Physical Therapist
  • Ellettsville, IN
  • NPI 1306260823
  NPD (past)
• David Ober Magnante, MD

  • Ophthalmology Physician
  • Lafayette, IN
  • NPI 1255309423
  NPD (past)
• Merlyn Malola, MD

  • Anesthesiology Physician
  • Rochester, IN
  • NPI 1912909854
  NPD (past)
• Padma P Ponugoti, M.D.

  • Ophthalmology Physician
  • Winamac, IN
  • NPI 1952419004
  NPD (past)
• Danielle Sawyer, PTA

  • Physical Therapy Assistant
  • Oklahoma City, OK
  • NPI 1164788410
  NPD (past)
• Derek J Sharvelle, MD

  • Ophthalmology Physician
  • Lafayette, IN
  • NPI 1548243926
  NPD (past)
• Robert Wayne Thompson Jr., M.D.

  • Ophthalmology Physician
  • Shawnee, KS
  • NPI 1366432361
  NPD (past)
• Jennifer Dye Wheelock, CCC-A, AU.D

  • Audiologist
  • Louisville, KY
  • NPI 1639158967
  NPD (past)

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

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1144619271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E LAKE COOK RD",
            "address_2": "SUITE 1100",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891999",
            "telephone_number": "800-317-0711",
            "fax_number": "877-821-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 E LAKE COOK RD",
            "address_2": "SUITE 1100",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891999",
            "telephone_number": "800-317-0711",
            "fax_number": "877-821-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMESOURCE HEALTHCARE SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-13",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "FLEMING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "800-317-0711"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016.003027",
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elena Presta, OTR/L
• Michelle N Price, DPT
• Primehealth Group LLC
• Primehealth of Illinois Inc
• Primehealth of Illinois LLC
• Primesource Healthcare Systems, Inc.
• Primesource Healthcare Systems, Inc.
• Aeba T Prince, PT
• Jordan Prince
• Priority Care, Inc.

• Podiatrist in Buffalo Grove, IL
• Providers in Buffalo Grove, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.