Edelson Pediatrics SC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

EDELSON PEDIATRICS SC

Practice address

15750 S Bell Rd Ste 2a
Homer Glen, IL 60491-8420

Phone

(708) 301-6004

NPI assigned

Jan 24, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Paul Frederic Edelson, MD

Title

Pediatrician President

Phone

(815) 588-3889

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202083200000",
    "number": "1154476638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15750 S BELL RD STE 2A",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604918420",
            "telephone_number": "708-301-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15750 S BELL RD STE 2A",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604918420",
            "telephone_number": "708-301-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDELSON PEDIATRICS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2008-02-04",
        "status": "A",
        "authorized_official_last_name": "EDELSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "FREDERIC",
        "authorized_official_title_or_position": "PEDIATRICIAN PRESIDENT",
        "authorized_official_telephone_number": "815-588-3889",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G19148",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Homer Glen, IL
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• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; 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.