S. David Demorest

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

S. DAVID DEMOREST

Practice address

8383 Belmont Avenue
River Grove, IL 60171

Phone

(708) 452-1200

Fax

(708) 452-0157

NPI assigned

Oct 9, 2007

Last updated

Oct 9, 2007By 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

Joseph L Giacchino Jr., MDNPI 1306901400

Title

Administrator/Owner

Phone

(708) 343-2500

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

J L Giacchinos D Demorest MD Assc2 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.

• J L Giacchino/S D Demorest MD Assc

  • Family Medicine Physician
  • Melrose Park, IL
  • NPI 1285823237
  NPD tax ID

Practitioners 2

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.

• Joseph L Giacchino Jr., MD

  • Family Medicine Physician
  • Melrose Park, IL
  • NPI 1306901400
  Authorized official Same address or phone
• Stanley David Demorest, MD

  • Family Medicine Physician
  • Melrose Park, IL
  • NPI 1982769071
  NPD (past)

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1235327941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O BOX 1624",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "60160",
            "telephone_number": "708-452-1200",
            "fax_number": "708-425-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8383 BELMONT AVENUE",
            "city": "RIVER GROVE",
            "state": "IL",
            "postal_code": "60171",
            "telephone_number": "708-452-1200",
            "fax_number": "708-452-0157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S. DAVID DEMOREST",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "GIACCHINO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "708-343-2500",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360677383",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "737320",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• River Grove Clinic
• River Grove Dental Associates LLC
• River Grove School District 85.5
• Robert Rutkowski DCPC
• Robert Rutkowski, D.C.
• David Shifman, D.C.
• Frank Siracusa, DDS
• Jared Sivinski, DPT
• Michael Leonard Siwek, D.D.S
• Angela Maria Snyder, MSN, FNP-BC

• Primary Care Clinic/Center in River Grove, IL
• Providers in River Grove, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.