Individual provider Active NPI

Bryon A Rosner, MD

  • Obstetrics & Gynecology Physician
  • Hazel Crest, IL
National Provider Identifier
1336219203
Registry record updated Oct 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036-078555 Issued in IL
Practice address
17850 S Kedzie
Suite 3100
Hazel Crest, IL 60429-2086
Phone
(708) 798-2400
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036078555 IL
Obstetrics & Gynecology Physician 207V00000X 036-078555 IL Primary

Addresses

Primary practice location

17850 S Kedzie
Suite 3100
Hazel Crest, IL 60429-2086

Mailing address

17850 S Kedzie
Suite 3100
Hazel Crest, IL 60429-2086
Phone (708) 798-2400

Other identifiers 1

IdentifierTypeStateIssuer
036078555MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-078555ILMDObstetrics & Gynecology Physician

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475798400000",
    "number": "1336219203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17850 S KEDZIE",
            "address_2": "SUITE 3100",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292086",
            "telephone_number": "708-798-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17850 S KEDZIE",
            "address_2": "SUITE 3100",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292086",
            "telephone_number": "708-798-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSNER",
        "first_name": "BRYON",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2016-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036078555",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036-078555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036078555",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazel Crest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; 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.