NPIMap

Organization Active NPI

Edward Health Ventures

  • Family Medicine Physician
  • Oswego, IL
National Provider Identifier
1255501029
Registry record updated Mar 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EDWARD HEALTH VENTURES
Practice address
6701 US Highway 34
Oswego, IL 60543-9129
Phone
(630) 646-4255
Fax
(630) 646-4256
NPI assigned
Mar 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2009

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

Authorized official

Name
Mr. William G. Kottman
Title
President
Phone
(630) 646-3950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

6701 US Highway 34
Oswego, IL 60543-9129

Mailing address

6701 US Highway 34
Oswego, IL 60543-9129
Phone (630) 646-4255

Other identifiers 1

IdentifierTypeStateIssuer
2221474OtherILBCBS OF ILLINOIS

Other names 1

  • Edward Medical Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031216000616 IL Part B Supplier - Clinic/Group Practice 4284531484 Receives reassigned benefits from 656 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1204848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238112000000",
    "number": "1255501029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 US HIGHWAY 34",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605439129",
            "telephone_number": "630-646-4255",
            "fax_number": "630-646-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 US HIGHWAY 34",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605439129",
            "telephone_number": "630-646-4255",
            "fax_number": "630-646-4256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD HEALTH VENTURES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-07",
        "last_updated": "2009-03-27",
        "status": "A",
        "authorized_official_last_name": "KOTTMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-646-3950",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS",
            "identifier": "2221474",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edward Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Oswego, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2009; 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.