Organization Active NPI

Southland Bone & Joint Institute, S.C.

  • Orthopaedic Surgery Physician
  • Olympia Fields, IL
National Provider Identifier
1194730960
Registry record updated Mar 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SOUTHLAND BONE & JOINT INSTITUTE, S.C.
Practice address
20060 Governors Dr
Suite 300
Olympia Fields, IL 60461-1029
Phone
(708) 283-2600
Fax
(708) 283-1250
NPI assigned
Jul 30, 2006
Last updated
Mar 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2009

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

Authorized official

Name
Wendi L Jeffers
Title
Office Manager
Phone
(708) 283-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

20060 Governors Dr
Suite 300
Olympia Fields, IL 60461-1029

Mailing address

20060 Governors Dr
Suite 300
Olympia Fields, IL 60461-1029
Phone (708) 283-2600

Other identifiers 2

IdentifierTypeStateIssuer
01632336OtherILBLUE SHIELD PROVIDER #
200394600BMedicaidIN

National Provider Directory

National Provider Directory

Locations

230 W John Casey Rd
Bourbonnais, IL 60914
Phone (708) 957-0505

400 S Kennedy Dr
Bradley, IL 60915
Phone (815) 928-8050

20060 Governors Dr
Ste 400
Olympia Fields, IL 60461
Phone (815) 283-2600

20060 Governors Dr
Fl 3
Olympia Flds, IL 60461

20060 Governors Dr
Ste 300
Olympia Flds, IL 60461
Phone (708) 283-2600

7550 Hohman Ave
Ste 400
Munster, IN 46321
Phone (219) 513-0660

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237248000000",
    "number": "1194730960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20060 GOVERNORS DR",
            "address_2": "SUITE 300",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611029",
            "telephone_number": "708-283-2600",
            "fax_number": "708-283-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20060 GOVERNORS DR",
            "address_2": "SUITE 300",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611029",
            "telephone_number": "708-283-2600",
            "fax_number": "708-283-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND BONE & JOINT INSTITUTE, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2009-03-17",
        "status": "A",
        "authorized_official_last_name": "JEFFERS",
        "authorized_official_first_name": "WENDI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "708-283-2600"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "01632336",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200394600B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia Fields, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; 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.