North Shore Sports Medicine and Orthopaedic Center, LTD.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

Legal business name

NORTH SHORE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, LTD.

Doing business as

Illinois Sports Medicine and Orthopaedic Centers

Practice address

1714 Milwaukee Ave
Glenview, IL 60025-1441

Phone

(847) 699-6810

Fax

(847) 699-2854

NPI assigned

Jun 20, 2006

Organization subpart

No

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

Authorized official

Name

Chadwick Prodromos, M.D.NPI 1265477699

Title

President

Phone

(847) 699-6810

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Illinois Sports Medicine and Orthopaedic Centers Doing business as

Medicare fee-for-service enrollment

Enrolled in IL, FL2 enrollments

Enrollment records 2

Locations

Practitioners 2

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

• Chadwick C Prodromos, M.D.

  • Orthopaedic Surgery Physician
  • Glenview, IL
  • NPI 1265477699

  FL

  Medicare reassignment Care Compare group Authorized official
• Angelo Miranda Dizon, PT

  • Physical Therapist
  • Glenview, IL
  • NPI 1093750408
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1316983315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 MILWAUKEE AVE",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600251441",
            "telephone_number": "847-688-6810",
            "fax_number": "847-699-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 MILWAUKEE AVE",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600251441",
            "telephone_number": "847-699-6810",
            "fax_number": "847-699-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "PRODROMOS",
        "authorized_official_first_name": "CHADWICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-699-6810",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP FOR DEPT OF LABOR",
            "identifier": "131650500",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "1618365",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "200030424",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Illinois Sports Medicine and Orthopaedic Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• North Shore Pediatric Therapy
• North Shore Pediatric Therapy
• North Shore Physicians Group, LLC
• North Shore Physicians Group, LLC
• North Shore Podiatry
• North Suburban Ophthalmologists, S.C.
• Northewestern Opthalmic Institute
• Northfield Townshp HS Dist 225
• Northfield Townshp HS Dist 225
• Northland Hearing Centers, Inc.

• Sports Medicine (Orthopaedic Surgery) Physician in Glenview, IL
• Providers in Glenview, IL by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; 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.