Bloomingdale General Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036067770 Issued in IL

Legal business name

BLOOMINGDALE GENERAL PEDIATRICS

Practice address

109 Fairfield Way
Suite 103
Bloomingdale, IL 60108-1583

Phone

(630) 894-3250

Fax

(630) 894-3280

NPI assigned

Oct 10, 2006

Last updated

May 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edwin Pascual, M.D

Title

President

Phone

(630) 894-3250

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

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.

• Gisela M Gonzalez, M.D.

  • Pediatrics Physician
  • Bloomingdale, IL
  • NPI 1932294618
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1295822120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 FAIRFIELD WAY",
            "address_2": "SUITE 103",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081583",
            "telephone_number": "630-894-3250",
            "fax_number": "630-894-3280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 FAIRFIELD WAY",
            "address_2": "SUITE 103",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081583",
            "telephone_number": "630-894-3250",
            "fax_number": "630-894-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGDALE GENERAL PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "PASCUAL",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-894-3250",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036067770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083477",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0002201004",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067770",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloomingdale Dental, PLLC
• Bloomingdale Family Dental LTD
• Bloomingdale Family Practice S.C
• Bloomingdale Fire Protection District 1
• Bloomingdale Foot & Ankle Associates, Inc
• Bloomingdale Open MRI, LLC
• Bloomingdale Optical,Inc
• Bloomingdale Pavilion, LLC
• Bloomingdale SCH Dist 13
• Bloomingdale Skilled Nursing Facility LLC (Bella Terra Bloomingdale)

• Pediatrics Physician in Bloomingdale, IL
• Providers in Bloomingdale, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; 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.