NPIMap

Organization Active NPI

Lawrence T. Kacmar M.D., S.C.

Doing business as The Center for Primary Care & Sports Medicine

  • Sports Medicine (Family Medicine) Physician
  • Aurora, IL
National Provider Identifier
1235225269
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
LAWRENCE T. KACMAR M.D., S.C.
Doing business as
The Center for Primary Care & Sports Medicine
Practice address
3965 75TH St
Suite 103
Aurora, IL 60504-7925
Phone
(630) 375-1625
Fax
(630) 375-1925
NPI assigned
Oct 5, 2006
Last updated
Jul 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

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

Authorized official

Name
Margaret M Cooley, LPN
Title
Office Manager
Phone
(630) 375-1625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X NU Primary

Addresses

Primary practice location

3965 75TH St
Suite 103
Aurora, IL 60504-7925

Mailing address

3965 75TH St
Suite 103
Aurora, IL 60504-7925
Phone (630) 375-1625

Other identifiers 5

IdentifierTypeStateIssuer
036091557MedicaidIL
0005442619OtherILAETNA
1767232OtherILUNITED HEALTHCARE
02232125OtherILBLUE CROSS BLUE SHIELD ILLINOIS
1903680OtherILCIGNA

Other names 1

  • The Center for Primary Care & Sports Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080710000074 IL Part B Supplier - Clinic/Group Practice 3173695079 Receives reassigned benefits from 1 practitioner
Practice locations: Naperville, IL; Aurora, IL

National Provider Directory

National Provider Directory
Tax ID family
Lawrence T Kacmar MD SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1235225269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3965 75TH ST",
            "address_2": "SUITE 103",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047925",
            "telephone_number": "630-375-1625",
            "fax_number": "630-375-1925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3965 75TH ST",
            "address_2": "SUITE 103",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047925",
            "telephone_number": "630-375-1625",
            "fax_number": "630-375-1925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE T. KACMAR M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "COOLEY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "630-375-1625",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036091557",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0005442619",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1767232",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ILLINOIS",
            "identifier": "02232125",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1903680",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Center for Primary Care & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.