NPIMap

Organization Active NPI

Pediatrics and Child Development Clinic Inc.

  • Developmental - Behavioral Pediatrics Physician
  • Algonquin, IL
National Provider Identifier
1265440663
Registry record updated Nov 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
036092453 Issued in IL
Legal business name
PEDIATRICS AND CHILD DEVELOPMENT CLINIC INC.
Practice address
2575 W Algonquin Rd
Suite a
Algonquin, IL 60102-9403
Phone
(847) 658-4574
Fax
(847) 587-6113
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2009

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

Authorized official

Name
Mussarat Arshad, MDNPI 1801968953
Title
Owner
Phone
(847) 658-4574

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0006X 036092453 IL Primary
Pediatric Neurodevelopmental Disabilities PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0008X 036092453 IL

Addresses

Primary practice location

2575 W Algonquin Rd
Suite a
Algonquin, IL 60102-9403

Mailing address

2575 W Algonquin Rd
Suite a
Algonquin, IL 60102-9403
Phone (847) 658-4574

Other identifiers 2

IdentifierTypeStateIssuer
036092453MedicaidIL
05628082OtherILBLUE CROSS/SHIELD

National Provider Directory

National Provider Directory

Locations

2575 W Algonquin Rd
Ste A
Algonquin, IL 60102
Phone (847) 658-4403

Practitioners & affiliated clinicians

Practitioners 2

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": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258416000000",
    "number": "1265440663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 W ALGONQUIN RD",
            "address_2": "SUITE A",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601029403",
            "telephone_number": "847-658-4574",
            "fax_number": "847-587-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 W ALGONQUIN RD",
            "address_2": "SUITE A",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601029403",
            "telephone_number": "847-658-4574",
            "fax_number": "847-587-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS AND CHILD DEVELOPMENT CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2009-11-17",
        "status": "A",
        "authorized_official_last_name": "ARSHAD",
        "authorized_official_first_name": "MUSSARAT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-658-4574",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "IL",
            "license": "036092453",
            "primary": true
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "IL",
            "license": "036092453",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036092453",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/SHIELD",
            "identifier": "05628082",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Algonquin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; 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.