NPIMap

Organization Active NPI

Benedictine University

  • Sports Medicine (Family Medicine) Physician
  • Lisle, IL
National Provider Identifier
1366072555
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
BENEDICTINE UNIVERSITY
Practice address
5700 College Rd
Lisle, IL 60532-2851
Phone
(630) 829-6154
NPI assigned
Jan 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Authorized official

Name
Mr. Nathan Vanraden, ATC
Title
Assistant Ad/Head Athletic Trainer
Phone
(630) 829-6154

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X Primary

Addresses

Primary practice location

5700 College Rd
Lisle, IL 60532-2851

Mailing address

5700 College Rd
Lisle, IL 60532-2851

Other names 1

  • Benedictine Athletic Rehab Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Benedictine University2 organizations share this tax ID, including this one
Part of
Benedictine University

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765411200000",
    "number": "1366072555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 COLLEGE RD",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605322851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 COLLEGE RD",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605322851",
            "telephone_number": "630-829-6154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENEDICTINE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-16",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A",
        "authorized_official_last_name": "VANRADEN",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "ASSISTANT AD/HEAD ATHLETIC TRAINER",
        "authorized_official_telephone_number": "630-829-6154",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benedictine Athletic Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; 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.