NPIMap

Organization Active NPI

Edward Health Ventures

Doing business as Edward Medical Group

  • Multi-Specialty Clinic/Center
  • Bolingbrook, IL
National Provider Identifier
1356632657
Registry record updated Dec 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
EDWARD HEALTH VENTURES
Doing business as
Edward Medical Group
Practice address
130 Weber Road
Ste 100
Bolingbrook, IL 60440-1519
Phone
(630) 646-5777
Fax
(630) 646-5729
NPI assigned
Apr 21, 2011
Last updated
Dec 14, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2015

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

Authorized official

Name
Bill Kottman
Title
President
Phone
(630) 646-3388

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

130 Weber Road
Ste 100
Bolingbrook, IL 60440-1519

Mailing address

130 Weber Road
Ste 100
Bolingbrook, IL 60440-1519
Phone (630) 646-5777

Other names 1

  • Edward Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031216000616 IL Part B Supplier - Clinic/Group Practice 4284531484 Receives reassigned benefits from 656 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Edw Hosp Womens CNTR F36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Practitioners & affiliated clinicians

Practitioners 5

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": "1303344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450051200000",
    "number": "1356632657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 WEBER ROAD",
            "address_2": "STE 100",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401519",
            "telephone_number": "630-646-5777",
            "fax_number": "630-646-5729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 WEBER ROAD",
            "address_2": "STE 100",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401519",
            "telephone_number": "630-646-5777",
            "fax_number": "630-646-5729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD HEALTH VENTURES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-21",
        "last_updated": "2015-12-14",
        "status": "A",
        "authorized_official_last_name": "KOTTMAN",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-646-3388"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edward Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.