NPIMap

Organization Active NPI

Swedishamerican Hospital

  • Family Medicine Physician
  • Belvidere, IL
National Provider Identifier
1164090635
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SWEDISHAMERICAN HOSPITAL
Practice address
1320 East Ave
Belvidere, IL 61008-4559
Phone
(779) 696-3000
NPI assigned
Jun 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

Authorized official

Name
Nicole L Golden
Title
Manager, Revenue Cycle
Phone
(779) 696-7317

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1320 East Ave
Belvidere, IL 61008-4559

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866
Phone (779) 696-7150

Other names 1

  • District 100 Wellness Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2225217District 100 Wellness Center1320 East Ave, Belvidere, IL 61008Certificate of waiverMay 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
HHM Radiation Oncology44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623369600000",
    "number": "1164090635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866",
            "telephone_number": "779-696-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 EAST AVE",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610084559",
            "telephone_number": "779-696-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWEDISHAMERICAN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-11",
        "last_updated": "2021-06-11",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "GOLDEN",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER, REVENUE CYCLE",
        "authorized_official_telephone_number": "779-696-7317"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "District 100 Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belvidere, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.