21St Century Urology, S.C.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

21ST CENTURY UROLOGY, S.C.

Practice address

14315 108TH Ave
Suite 230
Orland Park, IL 60467-5700

Phone

(708) 364-7000

Fax

(708) 364-8000

NPI assigned

Jul 30, 2006

Last updated

May 1, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert A. Bonzani, MDNPI 1376548750

Title

President

Phone

(708) 364-7000

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

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.

• Robert A Bonzani, MD

  • Urology Physician
  • Columbia, SC
  • NPI 1376548750
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1225043896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14315 108TH AVE",
            "address_2": "SUITE 230",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604675700",
            "telephone_number": "708-364-7000",
            "fax_number": "708-364-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14315 108TH AVE",
            "address_2": "SUITE 230",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604675700",
            "telephone_number": "708-364-7000",
            "fax_number": "708-364-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "21ST CENTURY UROLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "BONZANI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-364-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "5642652",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036097795",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.