NPIMap

Organization Active NPI

Orthopedics of Illinois - the Bone Joint and Sports Medicine Center S

Doing business as Ortho Illinois

  • Orthopaedic Surgery Physician
  • Normal, IL
National Provider Identifier
1255635892
Registry record updated Jul 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
036108279 Issued in IL
Legal business name
ORTHOPEDICS OF ILLINOIS - THE BONE JOINT AND SPORTS MEDICINE CENTER S
Doing business as
Ortho Illinois
Practice address
2200 Fort Jesse Rd Ste 250
Normal, IL 61761-6290
Phone
(309) 454-1616
NPI assigned
Dec 22, 2010
Last updated
Jul 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2011

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

Authorized official

Name
Stephen Stout
Title
Administrator
Phone
(309) 454-1616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 036108279 IL Primary

Addresses

Primary practice location

2200 Fort Jesse Rd Ste 250
Normal, IL 61761-6290

Mailing address

2200 Fort Jesse Rd Ste 250
Normal, IL 61761-6290
Phone (309) 454-1616

Other names 1

  • Ortho Illinois Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110707000485 IL Part B Supplier - Clinic/Group Practice 8325226707 Receives reassigned benefits from 8 practitioners
Practice locations: Normal, IL

National Provider Directory

National Provider Directory

Locations

1405 W Park St
Ste 306
Urbana, IL 61801
Phone (217) 337-1300

Practitioners & affiliated clinicians

Practitioners 8

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": "1292976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309996800000",
    "number": "1255635892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 FORT JESSE RD STE 250",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616290",
            "telephone_number": "309-454-1616",
            "fax_number": "309-454-5167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 FORT JESSE RD STE 250",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616290",
            "telephone_number": "309-454-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDICS OF ILLINOIS - THE BONE JOINT AND SPORTS MEDICINE CENTER S",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-22",
        "last_updated": "2011-07-07",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "309-454-1616"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "036108279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ortho Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; 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.