Bella T Prospero MD SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BELLA T PROSPERO MD SC

Practice address

17901 Governors Hwy
Suite 101
Homewood, IL 60430-1144

Phone

(708) 799-7193

Fax

(708) 799-3839

NPI assigned

Oct 24, 2005

Organization subpart

No

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

Authorized official

Name

Bella T Prospero, MD

Title

President

Phone

(708) 799-7193

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1346230257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1329",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604434329",
            "telephone_number": "708-747-5850",
            "fax_number": "708-747-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17901 GOVERNORS HWY",
            "address_2": "SUITE 101",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604301144",
            "telephone_number": "708-799-7193",
            "fax_number": "708-799-3839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLA T PROSPERO MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "PROSPERO",
        "authorized_official_first_name": "BELLA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-799-7193",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL GROUP NUMBER",
            "identifier": "01635492",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.