Hssi Mco SPV LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

HSSI MCO SPV LLC

Practice address

1851 Silver Cross Blvd
Ste 110
New Lenox, IL 60451

Phone

(815) 300-3060

NPI assigned

Feb 1, 2021

Organization subpart

No

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

Authorized official

Name

Amy Owens

Title

Director , Finance

Phone

(815) 300-7106

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1154912202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER CROSS BLVD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 SILVER CROSS BLVD",
            "address_2": "STE 110",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "60451",
            "telephone_number": "815-300-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HSSI MCO SPV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-01",
        "last_updated": "2021-02-01",
        "certification_date": "2021-01-14",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR , FINANCE",
        "authorized_official_telephone_number": "815-300-7106"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; 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.