Fullerton Kimball Medical & Surgical Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

7003181 Issued in IL

Legal business name

FULLERTON KIMBALL MEDICAL & SURGICAL CENTER

Practice address

3412 W Fullerton Ave
Chicago, IL 60647-2416

Phone

(773) 235-8000

NPI assigned

Mar 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Renlin Xia, M.DNPI 1790809960

Title

President

Phone

(773) 235-8000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Fullerton Kimball Medical Surgical CenterCCN 14C0001161

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 3

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

• Renlin Xia, MD

  • Pain Medicine Physician
  • Chicago, IL
  • NPI 1790809960
  Medicare reassignment NPD Authorized official
• Tian Xia, DO

  • Pain Medicine (Anesthesiology) Physician
  • Lombard, IL
  • NPI 1467492728
  Medicare reassignment NPD
• Sheel A Patel, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Portage, IN
  • NPI 1558657346

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397001600000",
    "number": "1205964103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472416",
            "telephone_number": "773-235-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472416",
            "telephone_number": "773-235-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON KIMBALL MEDICAL & SURGICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2014-04-09",
        "status": "A",
        "authorized_official_last_name": "XIA",
        "authorized_official_first_name": "RENLIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-235-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7003181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY CODE",
            "identifier": "261Q00000X",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Marie Fuller, PT, DPT
• Fullerton Dental Island LLC
• Fullerton Drake Medical Center
• Fullerton Family Dentistry, LTD
• Fullerton Kedzie Professional Pharmacy
• Fullerton Kimball Medical Group SC
• Fullerton Medical Surgical Center
• Fullerton MRI LLC
• Fullerton Occupational Medicine & Immediate Care SC
• Fullerton Rehabilitation Center

• Ambulatory Surgical Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.