NPIMap

Organization Active NPI

Wheaton Medical SC

Doing business as Illinois Back Institute

  • Family Medicine Physician
  • Carol Stream, IL
National Provider Identifier
1174879340
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WHEATON MEDICAL SC
Doing business as
Illinois Back Institute
Practice address
640 E Saint Charles Rd Ste 204, 205, 206
Carol Stream, IL 60188-3083
Phone
(630) 480-7155
Fax
(630) 447-9942
NPI assigned
Jul 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Authorized official

Name
Stella Zaimi
Title
Chief Operating Officer
Phone
(630) 677-3742

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Neuromuscular Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081N0008X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

640 E Saint Charles Rd Ste 204, 205, 206
Carol Stream, IL 60188-3083

Mailing address

640 E Saint Charles Rd Ste 204, 205, 206
Carol Stream, IL 60188-3083
Phone (630) 480-7155

Other identifiers 1

IdentifierTypeStateIssuer
68756OtherILCORPORATE LICENSE #

Other names 1

  • Illinois Back Institute Doing business as

National Provider Directory

National Provider Directory

Locations

640 E Saint Charles Rd
Ste 205
Carol Stream, IL 60188

640 E Saint Charles Rd
Ste 206
Carol Stream, IL 60188
Phone (630) 480-7155

1331 W 75th St
Ste 100
Naperville, IL 60540
Phone 6302210200108

11528 183rd Pl
Orland Park, IL 60467
Phone (708) 326-1700

315 S Naperville Rd
Wheaton, IL 60187
Phone (630) 492-1388

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1174879340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 E SAINT CHARLES RD STE 204, 205, 206",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601883083",
            "telephone_number": "630-480-7155",
            "fax_number": "630-447-9942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 E SAINT CHARLES RD STE 204, 205, 206",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601883083",
            "telephone_number": "630-480-7155",
            "fax_number": "630-447-9942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHEATON MEDICAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-25",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "ZAIMI",
        "authorized_official_first_name": "STELLA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "630-677-3742"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081N0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Neuromuscular Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE LICENSE #",
            "identifier": "68756",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Illinois Back Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Illinois Back Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carol Stream, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; 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.