Nepomuceno Medical Associates,SC.

Primary specialty

SpecialistTaxonomy code 174400000X

License

036069957 Issued in IL

Legal business name

NEPOMUCENO MEDICAL ASSOCIATES,SC.

Practice address

18811 Dixie Hwy
Suite 200
Homewood, IL 60430-3919

Phone

(708) 799-6363

Fax

(708) 799-6399

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Edilberto Elazegui Nepomuceno Jr., MD

Title

VP/Treasurer

Phone

(708) 799-6363

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617148800000",
    "number": "1225101926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604120370",
            "telephone_number": "708-799-6363",
            "fax_number": "708-799-6399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18811 DIXIE HWY",
            "address_2": "SUITE 200",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604303919",
            "telephone_number": "708-799-6363",
            "fax_number": "708-799-6399"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3700 W 203rd St Ste 112",
            "address_purpose": "LOCATION",
            "city": "Olympia Fields",
            "state": "IL",
            "postal_code": "604611181",
            "country_code": "US",
            "telephone_number": "708-679-2580",
            "fax_number": "708-503-3810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEPOMUCENO MEDICAL ASSOCIATES,SC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A",
        "authorized_official_last_name": "NEPOMUCENO",
        "authorized_official_first_name": "EDILBERTO",
        "authorized_official_middle_name": "ELAZEGUI",
        "authorized_official_title_or_position": "VP/TREASURER",
        "authorized_official_telephone_number": "708-799-6363",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036069957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Homewood, IL
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• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.