NPIMap

Organization Active NPI

Miinedoctor, Inc.

  • Internal Medicine Physician
  • Crestwood, IL
National Provider Identifier
1144795279
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MIINEDOCTOR, INC.
Practice address
13755 Cicero Ave
Crestwood, IL 60418-1824
Phone
(708) 972-7642
Fax
(708) 925-9179
NPI assigned
Oct 4, 2018
Last updated
Dec 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Authorized official

Name
Ashley RockNPI 1720854052
Title
Director of Clinical Operations
Phone
(708) 972-7636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

13755 Cicero Ave
Crestwood, IL 60418-1824

Mailing address

13755 Cicero Ave
Crestwood, IL 60418-1824
Phone (708) 972-7636

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address lfochesattofilho283947@direct.myadvocateaurora.org Direct
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190508001875 IL Part B Supplier - Clinic/Group Practice 7012259252 Receives reassigned benefits from 10 practitioners
Practice locations: Naperville, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1144795279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13755 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604181824",
            "telephone_number": "708-972-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13755 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604181824",
            "telephone_number": "708-972-7642",
            "fax_number": "708-925-9179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIINEDOCTOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-04",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "ROCK",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "708-972-7636"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lfochesattofilho283947@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "13755 Cicero Ave",
            "city": "Crestwood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604181824",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "13755 Cicero Ave",
            "city": "Crestwood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604181824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crestwood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.