NPIMap

Organization Active NPI

Countryside Medical SC

  • Specialist
  • Countryside, IL
National Provider Identifier
1366726283
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
COUNTRYSIDE MEDICAL SC
Practice address
6555 S Willow Springs Rd
Suites 1 & 2
Countryside, IL 60525
Phone
(708) 482-9700
Fax
(708) 482-0217
NPI assigned
Oct 11, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Lynnette McRoy
Title
Billing Coordinator
Phone
(773) 767-3822

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 0 IL Primary

Addresses

Primary practice location

6555 S Willow Springs Rd
Suites 1 & 2
Countryside, IL 60525

Mailing address

PO Box 700
Wheaton, IL 60187-0700
Phone (773) 767-3822

National Provider Directory

National Provider Directory

Locations

6555 Willow Springs Rd
Ste 1
La Grange Highlands, IL 60525
Phone (708) 482-9700

6555 Willow Springs Rd
Ste 12
La Grange Highlands, IL 60525
Phone (708) 482-9700

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1366726283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 700",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601870700",
            "telephone_number": "773-767-3822",
            "fax_number": "773-337-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6555 S WILLOW SPRINGS RD",
            "address_2": "SUITES 1 & 2",
            "city": "COUNTRYSIDE",
            "state": "IL",
            "postal_code": "60525",
            "telephone_number": "708-482-9700",
            "fax_number": "708-482-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE MEDICAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MCROY",
        "authorized_official_first_name": "LYNNETTE",
        "authorized_official_title_or_position": "BILLING COORDINATOR",
        "authorized_official_telephone_number": "773-767-3822"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Countryside, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.