NPIMap

Organization Active NPI

Hawthorne Physical Medicine

  • Preferred Provider Organization
  • Vernon Hills, IL
National Provider Identifier
1336175801
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
042-617702 Issued in IL
Legal business name
HAWTHORNE PHYSICAL MEDICINE
Practice address
977 Lakeview Pkwy
Suite#103
Vernon Hills, IL 60061-1400
Phone
(847) 932-1079
Fax
(847) 932-1082
NPI assigned
Jun 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Authorized official

Name
Bradley MattsonNPI 1437260783
Title
Owner
Phone
(847) 932-1079

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
Preferred Provider Organization 305R00000X 042-617702 IL Primary

Addresses

Primary practice location

977 Lakeview Pkwy
Suite#103
Vernon Hills, IL 60061-1400

Mailing address

977 Lakeview Pkwy
Suite#103
Vernon Hills, IL 60061-1400
Phone (847) 932-1079

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295913600000",
    "number": "1336175801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "977 LAKEVIEW PKWY",
            "address_2": "SUITE#103",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611400",
            "telephone_number": "847-932-1079",
            "fax_number": "847-932-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "977 LAKEVIEW PKWY",
            "address_2": "SUITE#103",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611400",
            "telephone_number": "847-932-1079",
            "fax_number": "847-932-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWTHORNE PHYSICAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2011-01-25",
        "status": "A",
        "authorized_official_last_name": "MATTSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-932-1079"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "042-617702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernon Hills, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; 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.