Active NPI
Innovative Physician Associates LLC
- Health Maintenance Organization
- Burr Ridge, IL
National Provider Identifier
1336482462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Maintenance Organization
- License
- 41053311
- Legal business name
- INNOVATIVE PHYSICIAN ASSOCIATES LLC
- Practice address
- 901 McClintock Drive
Suite 202
Burr Ridge, IL 60527-0844 - Phone
- (888) 220-6432
- Fax
- (630) 734-4715
- NPI assigned
- Mar 27, 2013
- Last updated
- Mar 27, 2013
- Organization subpart
- Yes
- Parent organization
- METRO INFECTIOUS DISEASE CONSULTANTS,LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Russell M. Petrak, M.D.
- Title
- Managing Partner
- Phone
- (888) 220-6432
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | 41053311 | IL | Primary |
Addresses
Primary practice location
901 McClintock Drive
Suite 202
Burr Ridge, IL 60527-0844
Mailing address
901 McClintock Drive
Suite 202
Burr Ridge, IL 60527-0844
Phone (888) 220-6432
National Provider Directory
National Provider Directory- Part of
- Metro Inf Disease Cons LLC
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.
-
- Infectious Disease Physician
- Burr Ridge, IL
- NPI 1376539692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364342400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1364342400000",
"number": "1336482462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 MCCLINTOCK DRIVE",
"address_2": "SUITE 202",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605270844",
"telephone_number": "888-220-6432",
"fax_number": "630-734-4715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 MCCLINTOCK DRIVE",
"address_2": "SUITE 202",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605270844",
"telephone_number": "888-220-6432",
"fax_number": "630-734-4715"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INNOVATIVE PHYSICIAN ASSOCIATES LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "METRO INFECTIOUS DISEASE CONSULTANTS,LLC",
"enumeration_date": "2013-03-27",
"last_updated": "2013-03-27",
"status": "A",
"authorized_official_last_name": "PETRAK",
"authorized_official_first_name": "RUSSELL",
"authorized_official_middle_name": "M.",
"authorized_official_title_or_position": "MANAGING PARTNER",
"authorized_official_telephone_number": "888-220-6432",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "302R00000X",
"taxonomy_group": "",
"desc": "Health Maintenance Organization",
"state": "IL",
"license": "41053311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burr Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.