NPIMap

Organization Active NPI

Back to Basics Pediatrics SC

  • Pediatrics Physician
  • Algonquin, IL
National Provider Identifier
1205310356
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
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
Last updated
Dec 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Authorized official

Name
Dr. Christine Poulos, MDNPI 1679678874
Title
Pediatrician
Phone
(224) 520-0087

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

2403 Harnish Dr Ste 101
Algonquin, IL 60102-6803

Mailing address

2403 Harnish Dr Ste 101
Algonquin, IL 60102-6803
Phone (224) 333-0730

Other names 1

  • Back to Basics Pediatrics, S Corp Other name

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
14D2156257Back to Basics Pediatrics, S C2403 Harnish Dr - Ste 101, Algonquin, IL 60102Certificate of waiverOct 11, 2026

National Provider Directory

National Provider Directory

Locations

2403 Harnish Dr
Ste 101
Algonquin, IL 60102
Phone (224) 333-0730

Practitioners & affiliated clinicians

Practitioners 3

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": "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"
        }
    ]
}

Other providers in Algonquin, IL

Sources for this page

  • 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.