NPIMap

Organization Active NPI

Adventist Health Partners, Inc

Doing business as Adventist Bolingbrook Anesthesia

  • Anesthesiology Physician
  • Bolingbrook, IL
National Provider Identifier
1366624256
Registry record updated Jun 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ADVENTIST HEALTH PARTNERS, INC
Doing business as
Adventist Bolingbrook Anesthesia
Practice address
500 Remington Blvd
Bolingbrook, IL 60440-4923
Phone
(630) 856-3075
NPI assigned
Dec 3, 2007
Last updated
Jun 12, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVENTIST HEALTH PARTNERS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2017

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

Authorized official

Name
Mrs. Ruby Mann
Title
Director of Managed Care
Phone
(630) 312-6884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

500 Remington Blvd
Bolingbrook, IL 60440-4923

Mailing address

PO Box 7009
Bolingbrook, IL 60440-7009
Phone (630) 312-7800

Other names 1

  • Adventist Bolingbrook Anesthesia Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040127000064 IL Part B Supplier - Clinic/Group Practice 0244135762 Receives reassigned benefits from 392 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Maple Avenue Medical Ce

Practitioners & affiliated clinicians

Practitioners 3

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": "1196640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497225600000",
    "number": "1366624256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7009",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604407009",
            "telephone_number": "630-312-7800",
            "fax_number": "630-312-7902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404923",
            "telephone_number": "630-856-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST HEALTH PARTNERS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVENTIST HEALTH PARTNERS, INC",
        "enumeration_date": "2007-12-03",
        "last_updated": "2017-06-12",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "RUBY",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "630-312-6884",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adventist Bolingbrook Anesthesia",
            "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 Jun 12, 2017; 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.