Back to Basics Pediatrics SC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

BACK TO BASICS PEDIATRICS SC

Practice address

2403 Harnish Dr Ste 101
Algonquin, IL 60102-6803

Phone

(224) 520-0087

NPI assigned

Sep 24, 2018

Organization subpart

No

Name

Dr. Christine Poulos, MD

Title

Pediatrician

Phone

(224) 520-0087

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joyce Elugbadebo, MD

  • Pediatrics Physician
  • Algonquin, IL
  • NPI 1952782955

  Pediatrics

  NPD (past)
• Rocio Vargas, CPNP-PC

  • Pediatric Nurse Practitioner
  • Algonquin, IL
  • NPI 1710703228
  NPD (past)

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

CLIA laboratory certificates

Locations

• Back to Basics Pediatrics, S Corp Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 12, 2018.

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544572800000",
    "number": "1205310356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 HARNISH DR STE 101",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601026803",
            "telephone_number": "224-333-0730",
            "fax_number": "224-333-0748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 HARNISH DR STE 101",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601026803",
            "telephone_number": "224-520-0087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO BASICS PEDIATRICS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-24",
        "last_updated": "2018-12-12",
        "status": "A",
        "authorized_official_last_name": "POULOS",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "224-520-0087",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Back to Basics Pediatrics, S Corp",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Back to Basics Pediatrics, S Corp",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Atkinson Eye Care, P.C.
• William R Atkinson, O.D.
• Av360 LLC
• Jakob Awender, DPT
• Back of America LTD.
• Tanvi Arora Bakshi, DMD
• Yelena Balaban, FNP-BC
• Michelle Banach, MSN- APRN-FNP-C
• Susan Jean Banjavcic, COTA L
• Gayle Patricia Barnes, OTR/L

• All providers in Algonquin, IL
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; 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.