NPIMap

Organization Active NPI

River Forest Surgery Center LLC

  • Certified Registered Nurse Anesthetist
  • River Forest, IL
National Provider Identifier
1194727727
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
RIVER FOREST SURGERY CENTER LLC
Practice address
7427 Lake St
River Forest, IL 60305-1817
Phone
(708) 488-1200
Fax
(708) 771-7321
NPI assigned
Aug 12, 2005
Last updated
Apr 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Authorized official

Name
Lisa Gill
Title
Administrator
Phone
(708) 771-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X IL Primary

Addresses

Primary practice location

7427 Lake St
River Forest, IL 60305-1817

Mailing address

7427 Lake St
River Forest, IL 60305-1817
Phone (708) 488-1200

Other identifiers 1

IdentifierTypeStateIssuer
CDK3019OtherRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040510000254 IL Part B Supplier - Clinic/Group Practice 6800885492 Receives reassigned benefits from 5 practitioners
Practice locations: River Forest, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
River Forest Surgery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

7427 Lake St
River Forest, IL 60305
Phone (708) 488-1200

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1194727727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7427 LAKE ST",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051817",
            "telephone_number": "708-488-1200",
            "fax_number": "708-771-0841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7427 LAKE ST",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051817",
            "telephone_number": "708-488-1200",
            "fax_number": "708-771-7321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER FOREST SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-12",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "708-771-3334"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CDK3019",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in River Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.