Organization Active NPI

John V. White, MD, LLC

  • Vascular Surgery Physician
  • Niles, IL
National Provider Identifier
1215251541
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
036067291 Issued in IL
Legal business name
JOHN V. WHITE, MD, LLC
Practice address
8816 W Dempster St
Niles, IL 60714-5109
Phone
(847) 518-1762
Fax
(847) 723-3007
NPI assigned
Mar 15, 2010
Reactivated
Dec 1, 2010
Last updated
Dec 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

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

Authorized official

Name
Constance E Ryjewski, APNNPI 1861613507
Title
Office Manager
Phone
(847) 518-1762

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 036067291 IL Primary

Addresses

Primary practice location

8816 W Dempster St
Niles, IL 60714-5109

Mailing address

8816 W Dempster St
Niles, IL 60714-5109
Phone (847) 518-1762

Other identifiers 2

IdentifierTypeStateIssuer
036067291MedicaidIL
0001632574OtherILBLUECROSS/BLUESHIELD

National Provider Directory

National Provider Directory

Locations

8816 W Dempster St
Niles, IL 60714
Phone (773) 321-2800

Practitioners & affiliated clinicians

Practitioners 1

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": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291161600000",
    "number": "1215251541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8816 W DEMPSTER ST",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607145109",
            "telephone_number": "847-518-1762",
            "fax_number": "847-723-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8816 W DEMPSTER ST",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607145109",
            "telephone_number": "847-518-1762",
            "fax_number": "847-723-3007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN V. WHITE, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-15",
        "last_updated": "2010-12-01",
        "deactivation_date": "2010-04-05",
        "reactivation_date": "2010-12-01",
        "status": "A",
        "authorized_official_last_name": "RYJEWSKI",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "847-518-1762",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036067291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067291",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD",
            "identifier": "0001632574",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; 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.