Organization Active NPI

Surgery Group SC

  • Surgery Physician
  • Geneva, IL
National Provider Identifier
1235213802
Registry record updated Nov 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SURGERY GROUP SC
Practice address
1665 South St
Geneva, IL 60134-2542
Phone
(630) 208-7874
Fax
(630) 208-7880
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2012

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

Authorized official

Name
Jodi Krusely
Title
Account Manager
Phone
(847) 838-3832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1665 South St
Geneva, IL 60134-2542

Mailing address

1665 South St
Geneva, IL 60134-2542
Phone (630) 208-7874

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061109000150 IL Part B Supplier - Clinic/Group Practice 8426055294 Receives reassigned benefits from 2 practitioners
Practice locations: Geneva, IL

National Provider Directory

National Provider Directory

Locations

1710 N Randall Rd
Ste 320
Elgin, IL 60123
Phone (847) 697-4700

87 N Airlite St
Ste 150
Elgin, IL 60123
Phone (847) 697-5141

1665 South St
Geneva, IL 60134
Phone (630) 208-7874

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352332800000",
    "number": "1235213802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1665 SOUTH ST",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601342542",
            "telephone_number": "630-208-7874",
            "fax_number": "630-208-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 SOUTH ST",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601342542",
            "telephone_number": "630-208-7874",
            "fax_number": "630-208-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY GROUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2012-11-08",
        "status": "A",
        "authorized_official_last_name": "KRUSELY",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "847-838-3832"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; 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.