NPIMap

Organization Active NPI

University of Wisconsin Medical Foundation

Doing business as Retina Consultants, UWMF

  • Ophthalmology Physician
  • Rockford, IL
National Provider Identifier
1225150709
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
Doing business as
Retina Consultants, UWMF
Practice address
345 Executive Pkwy
Suite M4
Rockford, IL 61107-5340
Phone
(815) 399-1141
Fax
(815) 397-7816
NPI assigned
Apr 4, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jeffrey Grossman, MD
Title
President and Ceo
Phone
(815) 399-1141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

345 Executive Pkwy
Suite M4
Rockford, IL 61107-5340

Mailing address

345 Executive Pkwy
Suite M4
Rockford, IL 61107-5340
Phone (815) 399-1141

Other identifiers 1

IdentifierTypeStateIssuer
10121807OtherILBCBS OF IL GROUP NUMBER

Other names 1

  • Retina Consultants, UWMF Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Uwmf Inc Fam Prac26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

345 Executive Pkwy
Ste M4
Rockford, IL 61107
Phone (815) 399-1141

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225150709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 EXECUTIVE PKWY",
            "address_2": "SUITE M4",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075340",
            "telephone_number": "815-399-1141",
            "fax_number": "815-397-7816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 EXECUTIVE PKWY",
            "address_2": "SUITE M4",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075340",
            "telephone_number": "815-399-1141",
            "fax_number": "815-397-7816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GROSSMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "815-399-1141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL GROUP NUMBER",
            "identifier": "10121807",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Retina Consultants, UWMF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.