NPIMap

Organization Active NPI

Resurrection Services

Doing business as Presence Medical Group

  • Family Medicine Physician
  • Park Ridge, IL
National Provider Identifier
1235495631
Registry record updated Apr 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036080241 Issued in IL
Legal business name
RESURRECTION SERVICES
Doing business as
Presence Medical Group
Practice address
205 S Northwest Hwy
Suite 130
Park Ridge, IL 60068-5802
Phone
(847) 292-5200
NPI assigned
Apr 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2012

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

Authorized official

Name
Daniel McCormick
Title
Senior Vice President
Phone
(708) 583-6817

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 036080241 IL Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 036054785 IL

Addresses

Primary practice location

205 S Northwest Hwy
Suite 130
Park Ridge, IL 60068-5802

Mailing address

62311 Collection Center Dr
Chicago, IL 60693-0623
Phone (800) 273-2614

Other identifiers 1

IdentifierTypeStateIssuer
745367OtherILMEDICARE PTAN

Other names 1

  • PRESENCE MEDICAL GROUP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050215000965 IL Part B Supplier - Clinic/Group Practice 2860396769 Receives reassigned benefits from 128 practitioners
47 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 46

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 46

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334620800000",
    "number": "1235495631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62311 COLLECTION CENTER DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606930623",
            "telephone_number": "800-273-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S NORTHWEST HWY",
            "address_2": "SUITE 130",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600685802",
            "telephone_number": "847-292-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESURRECTION SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2012-04-17",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "708-583-6817"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036080241",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036054785",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "745367",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRESENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.