NPIMap

Organization Active NPI

Northwestern Specialists in Plastic Surgery, S.C.

  • Plastic Surgery Physician
  • Chicago, IL
National Provider Identifier
1306079298
Registry record updated Mar 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
36-049906 Issued in IL
Legal business name
NORTHWESTERN SPECIALISTS IN PLASTIC SURGERY, S.C.
Practice address
676 N Saint Clair St
1525A
Chicago, IL 60611-2927
Phone
(312) 266-6240
Fax
(312) 266-1411
NPI assigned
Aug 26, 2009
Last updated
Mar 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2015

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

Authorized official

Name
Dr. Neil Fine, M.D.NPI 1841226719
Title
President
Phone
(312) 266-6240

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 36-049906 IL Primary

Addresses

Primary practice location

676 N Saint Clair St
1525A
Chicago, IL 60611-2927

Mailing address

676 N Saint Clair St
1575
Chicago, IL 60611-2927
Phone (312) 266-6240

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091014000506 IL Part B Supplier - Clinic/Group Practice 2769528256 Receives reassigned benefits from 4 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1251244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1306079298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST",
            "address_2": "1575",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112927",
            "telephone_number": "312-266-6240",
            "fax_number": "312-266-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST",
            "address_2": "1525A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112927",
            "telephone_number": "312-266-6240",
            "fax_number": "312-266-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN SPECIALISTS IN PLASTIC SURGERY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-26",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "FINE",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-266-6240",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "36-049906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.