NPIMap

Organization Active NPI

Carlson Orthopedic Clinic SC

  • Specialist
  • Rockford, IL
National Provider Identifier
1245342666
Registry record updated Sep 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036073115 Issued in IL
Legal business name
CARLSON ORTHOPEDIC CLINIC SC
Practice address
1848 Daimler Rd
Rockford, IL 61112-1019
Phone
(815) 398-9100
Fax
(815) 986-6770
NPI assigned
Aug 31, 2006
Last updated
Sep 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2010

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

Authorized official

Name
Dr. Mark E Carlson, MDNPI 1790741049
Title
MD
Phone
(815) 398-9100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036073115 IL Primary

Addresses

Primary practice location

1848 Daimler Rd
Rockford, IL 61112-1019

Mailing address

1848 Daimler Rd
Rockford, IL 61112-1019
Phone (815) 398-9100

Other identifiers 1

IdentifierTypeStateIssuer
216892OtherILMEDICARE PTAN

National Provider Directory

National Provider Directory

Locations

1848 Daimler Rd
Rockford, IL 61112
Phone (815) 229-2500

1848 Daimler Rd
Ste 1
Rockford, IL 61112
Phone (815) 398-9100

Practitioners & affiliated clinicians

Practitioners 4

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283904000000",
    "number": "1245342666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121019",
            "telephone_number": "815-398-9100",
            "fax_number": "815-986-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1848 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121019",
            "telephone_number": "815-398-9100",
            "fax_number": "815-986-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLSON ORTHOPEDIC CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-09-08",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "815-398-9100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036073115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "216892",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 8, 2010; 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.