South Park Pediatrics, Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036-168196 Issued in IL

Legal business name

SOUTH PARK PEDIATRICS, INC

Practice address

15821 South Park
South Holland, IL 60473-1506

Phone

(708) 225-0200

Fax

(708) 225-0202

NPI assigned

Dec 19, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Wendell Wheeler, M.D.NPI 1902808611

Title

Ceo

Phone

(708) 225-0200

Specialties & licenses 1

Addresses

Other names 2

• South Park Pediatrics Doing business as
• South Park Pediatrics, Inc Doing business as

Electronic endpoints 1

Locations

Practitioners 2

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

• Wendell A Wheeler, M.D.

  • Pediatrics Physician
  • South Holland, IL
  • NPI 1902808611
  NPD Authorized official
• Jennifer Norris Rosas, A.P.N.

  • Family Nurse Practitioner
  • South Holland, IL
  • NPI 1134348246
  NPD (past)

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1346424876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15821 SOUTH PARK",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731506",
            "telephone_number": "708-225-0200",
            "fax_number": "708-225-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15821 SOUTH PARK",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731506",
            "telephone_number": "708-225-0200",
            "fax_number": "708-225-0202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1052 W 111th St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606434635",
            "country_code": "US",
            "telephone_number": "773-779-7337",
            "fax_number": "773-779-2229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH PARK PEDIATRICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-225-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-168196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "15821 South Park",
            "city": "South Holland",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604731506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "South Park Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Park Pediatrics, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Holland Manor HRC LLC
• South Holland Physical Therapy & Rehabilitation, LTD.
• South Holland School District - 151
• South Loop Counseling Services, LLC
• South Park Dental Care
• South Park Pediatrics, Inc
• South Suburban Physical Therapy LTD
• Southwest Community Services, Inc.
• Southwest Community Services, Inc.
• Glendolyn Spencer

• Pediatrics Physician in South Holland, IL
• Providers in South Holland, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; 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.