Palos Medical Group, LLC.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

PALOS MEDICAL GROUP, LLC.

Practice address

15300 West Ave
Orland Park, IL 60462-4600

Phone

(708) 590-5304

Fax

(708) 590-5308

NPI assigned

Dec 18, 2009

Organization subpart

No

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

Authorized official

Name

Terrence C MoisanNPI 1699722793

Title

President, Ceo

Phone

(708) 923-5000

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Palos Community Hospital

  • General Acute Care Hospital
  • Palos Heights, IL
  • NPI 1851386692

  Member Of

  NPD member

Practitioners 1

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

• Terrence C Moisan, M.D.

  • Pulmonary Disease Physician
  • Palos Heights, IL
  • NPI 1699722793
  NPD Authorized official

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

{
    "created_epoch": "1261094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706227200000",
    "number": "1255660312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE STE 1630",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631256",
            "telephone_number": "708-923-5173",
            "fax_number": "708-923-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15300 WEST AVE",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624600",
            "telephone_number": "708-590-5304",
            "fax_number": "708-590-5308"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12251 S 80th Ave",
            "address_purpose": "LOCATION",
            "city": "Palos Heights",
            "state": "IL",
            "postal_code": "604631256",
            "country_code": "US",
            "telephone_number": "708-590-5304",
            "fax_number": "708-590-5308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PALOS MEDICAL GROUP, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-18",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A",
        "authorized_official_last_name": "MOISAN",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "708-923-5000"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36102101",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medicaldocumentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Palos Community Hospital
• Palos Community Hospital
• Palos Community Hospital (Icc Physician Group)
• Palos Health Surgery Center, LLC
• Palos Imaging, LLC
• Brandon Edward Palumbo
• Brianna Panka, LCSW
• Adar Panner
• John A Panozzo, M.D.
• Richard J Pape, D.D.S

• Obstetrics & Gynecology Physician in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; 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.