North Branch Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036133358 Issued in IL

Legal business name

NORTH BRANCH DERMATOLOGY LLC

Practice address

7411 N Milwaukee Ave
Niles, IL 60714-3707

Phone

(773) 763-6000

Fax

(773) 763-6006

NPI assigned

Aug 26, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Elizabeth N. Fahrenbach, M.D.NPI 1609003557

Title

Owner

Phone

(847) 254-2193

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth Nord Fahrenbach, M.D.

  • Dermatology Physician
  • Niles, IL
  • NPI 1609003557
  Medicare reassignment Care Compare group NPD Authorized official
• Megan Bonis

  • Gerontology Nurse Practitioner
  • Niles, IL
  • NPI 1922776186
  Medicare reassignment Care Compare group NPD
• Katherine Janezic, NP

  • Dermatology Physician
  • Niles, IL
  • NPI 1114551983
  Medicare reassignment Care Compare group NPD
• Joanna Katherine Jaros, MD

  • Dermatology Physician
  • Niles, IL
  • NPI 1447712492

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Caryn Rachel Olshansky, PA-C

  • Physician Assistant
  • Niles, IL
  • NPI 1033644992
  Medicare reassignment Care Compare group
• Gary Richard Fahrenbach, M.D.

  • Rheumatology Physician
  • Niles, IL
  • NPI 1043303803
  NPD
• Anne Therese Bittick, APN

  • Nurse Practitioner
  • Chicago, IL
  • NPI 1265784888
  NPD (past)

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

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1154721348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7411 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607143707",
            "telephone_number": "773-763-6000",
            "fax_number": "773-763-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7411 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607143707",
            "telephone_number": "773-763-6000",
            "fax_number": "773-763-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BRANCH DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "FAHRENBACH",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-254-2193",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036133358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Niles, IL
• Providers in Niles, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.